Intravenous Anesthetic Agents-1

1
Department of Anesthesiology - Jordan University of Science and

Technology Irbid-Jordan
Dr. Med. Khaled Radaideh
30 Dec 2015
INTRAVENOUS
ANAESTHETIC
AGENTS
INTRA VENOUS ANAESTHETIC AGENT
1- Properties of the ideal intravenous anesthetic agent

2- Classification of the intravenous anesthetic agent
3- Sodium Thiopental
3.1. Definition
3.2. Classification
3.3. Physical chemical properties
3.4. Pharmacokinetics
3.5. Pharmacodynamics
3.6. Dose and Administration
3.7. Indication, contraindication and precautions
3.8. Side Effects
30 Dec 2015
OBJECTIVES
4- Propofol
4.1. Physical and chemical properties
4.2. Dosage
4.3. Effects on organ systems
4.4. Indication and contraindication
5. Ketamine
5.1. definition of dissociative anesthesia
5.2. Physical & chemical Properties
5.3. Pharmacokinetics (Route of administration and Dosage)
5.4. Metabolism
5.5. Mechanism of action
5.6. Pharmacodynamics (effect on organ systems)
5.7. Indications and contraindications
30 Dec 2015
OBJECTIVES

30 Dec 2015
OBJECTIVES
6- Benzodiazepines
6.1. Features
6.2. Mode of action
6.3. Midazolam and Diazepam (Uses, differences between
them)
6.4. Benzodiazepine antagonists (Flumazenil)

7. Narcotic Agonists
7.1. Origin, Site of action and Receptors
7.2. Pharmacokinetics
7.3. Pharmacodynamics (effect on organ systems)
5.4. Fentanyl And Morphine
8. Narcotic Antagonists (Naloxone)
30 Dec 2015
PROPERTIES OF THE IDEAL INTRA

VENOUS ANAESTHETIC AGENT{1 OF 3}
1-rapid onset: achieved by an agent that is mainly :

A- un-ionized at blood ph(7.35 7.45)
B- highly lipid soluble
** these properties permit penetration of the BBB
2-rapid recovery:
-early recovery of consciousness is usually produced by rapid
redistribution of the drug from brain into other well-perfused tissues
particularly muscles
-plasma conc. Of drug decreases & drug diffuses out of the brain along a
conc. gradient
-quality of the recovery period is more related to the rate of metabolism
of the drug
* Drugs with slow metabolism are with a more prolonged hangover effect
5
(fatigue, weakness, pain, nuasea vomiting..etc )and accumulate if used
in repeated doses or by infusion for maintenance of anesthesia
3- analgesia at sub anesthetic concentrations

*analgesia :an absence of the sense of pain without loss of consciousness
30 Dec 2015
PROPERTIES OF THE IDEAL INTRA

VENOUS ANAESTHETIC AGENT {2 of 3}
4- minimal cardiovascular and resp. depression

5- no emetic effects
6- no excitatory phenomena
e.g. coughing .hiccup ,involuntary movements
7-no emergence phenomena
e.g. nightmares
8-no interaction with neuromuscular blocking drugs(muscle relaxant)
*Neuromuscular blocking drugs relax skeletal muscles and induce paralysis.
16-no stimulation of porphyria
The length of time a product may be stored without becoming unsuitable

for use or consumption.
30 Dec 2015
PROPERTIES OF THE IDEAL INTRA VENOUS

ANAESTHETIC AGENT {3 of 3}
9- no pain on injection
10- no venous sequelae(such as thrombosis)
11-no toxic effects on other organs
12- no release of histamine(bronchospasm
..itching)
13- no hypersensitivity reactions
14- water soluble formulation
15- long shelf life :
INTRAVENOUS ANAESTHETIC
AGENTS
30 Dec 2015
1- Barbiturate
1.1. sodium thiopental(used
for over 40 years)
2. Non barbiturate
2.1. propofol (newly
introduced)
2.2. ketamine (infrequently
used)
2.3. Etomidate
4. other adjuvant intravenous
anesthetic agents
(benzodiazepines,
midazolam, diazepam,)
30 Dec 2015
SODIUM THIOPENTAL
Definition:
(PENTOTHAL)
ultra short acting barbiturate

Classification:
IV anesthetic-hypnotic
Physical chemical properties :
-Its a Yellow powder with a sulphuric
smell and a bitter taste
-highly lipid soluble compound
-when combined with sodium
carbonate it becomes water soluble
9
ph of 10.6 to10.8
-*when injected ,sodium bicarbonate
is neutralized and the thiopental is
converted to its lipid soluble non
ionazed form(40% ionized at
ph=7.4)
-its highly protien bound by
albumen(75%)
Which prevents precipition out of
solution in vivo
30 Dec 2015
SODIUM THIOPENTAL
-its
bacteriostatic in water and has a
(PENTOTHAL)
10
Sodium thiopental (pentothal)
thiopental(yellow powder) is
dissolved in water& sodium carbonate to
make a 2.5% solution (25mg/ml)
30 Dec 2015
Supplied:
-Its stable at room temp for 2 weeks
Thiopental is a core medicine in the World

Health Organization's "Essential Drugs
List", which is a list of minimum medical
needs for a basic health care system
11
SODIUM THIOPENTAL
(PENTOTHAL)
-time required to render the patient unconscious

is generally
30-60 secs after administration .this is called the
arm brain circulation time
-An IV dose of 3-5 mg/kg results in loss of

consciousness
30 Dec 2015
Pharmacokinetics
-arm brain circulation time

is the time required for the drug to pass from site of
injection to the brain as it passes through the right
heart ,pulmonary circ., and the left heart
12

-with
So is most commonly used in the

induction phase of general
anesthesia
As with all lipid soluble anesthetic
drugs, the short duration of action
of Sodium thiopental is almost
entirely due to its redistribution
away from central circulation
towards muscle and fat tissue.
no other drugs ,the anesthetic

state persists for 5-10 mins
Its concentration is low enough in
the brain such that
consciousness returns.
30 Dec 2015
Pharmacokinetics
13
-liver &renal disease may be associated with low albumin levels

so result in an increase in free thiopental which inc. the anesthetic
toxicity and potency
-metabolism occurs primarily in the liver with approximately 10 to
15%of the drug level metabolized per hour
-sulphur containing drugs , acidosis, NSAIDS may displace

thiopental from albumen
30 Dec 2015
Pharmacokinetics
-a desulfuration rxn in liver produces pentobarbital which under goes

oxidative metabolism yielding 2 compounds with no anesthetic
activity
-less than 1% of the drug is excreted unchanged in the urine
14
SODIUM THIOPENTAL
(PENTOTHAL)
CNS: barbiturates interact with chloride ion channels by
-thiopental will decrease both cerebral electrical & metabolic activity

So it can be used to stop seizures activity in emergency
situations
-to maintain depression of cerebral electrical activity very high dose
are required
-But to maintian seizure control & avoid cv depression from high
dose of thiopental other drugs are used (e.g. benzodiazepines)
altering the duration they spend in an open state

-this facilitates inhibitory neurotrasmitters such as gama amino
butyric acid(GABA)
As well as blocking excitatory NTM actions such as glutamic acid
30 Dec 2015
pharmacodynamics
15
SODIUM THIOPENTAL
(PENTOTHAL)
thiopental BUT The improvement of ICP requires high

dose of thiopental to be maintained
The reduction of ICP is due to cerebral vasoconstriction,
reduced cerb. Metabolism &oxygen requirments
associated with dec.cerebral blood volume
-theopental has an an anti-analgesic effect, since low
dose may decrease pain threshold
CNS: Elevated ICP can quickly be reduced by
30 Dec 2015
pharmacodynamics
Intraocular pressure decreases
up to 25% with 3-5mg/kg of thiopental and persists for

3 to 5 minutes
16
SODIUM THIOPENTAL
(PENTOTHAL)
of myocardial function as measured by CO,SV, and

blood pressure
-coronary blood flow, heart rate ,&myocardial oxygen
uptake all increase following thiopental administration
-venous tone decreases (decreased preload)
And contributes to the increase in HR and decrease in
BP
-little change in total peripheral resistance
CVS:-thiopental causes a dose related depression
30 Dec 2015
Pharmacodynamics
17
SODIUM THIOPENTAL
(PENTOTHAL)
-FRC is reduced by 20% with induction of

anasthesia
>Functional Residual Capacity (FRC) is the volume of air
present in the lungs at the end of passive expiration.
-laryngospasm and bronchoconstriction may

be associated with light levels of thiopental and
with airway manipulation or intubation
30 Dec 2015
Pharmacodynamics
Respiratory:-induction of anesthesia with
thiopental may be associated with 2 or 3 large
breaths followed by apnea for less than 1min
-there is dose related depression of the
respiratory response to hypercarbia and
hypoxia
18
SODIUM THIOPENTAL
(PENTOTHAL)
GI:
GU/pregnancy/fetus:
- Thiopental has little or no effect on the kidneys

or gravid uterus.
-although thiopental crosses the placenta
It has no significant effect on the fetus when used
for cesarean section (dose used is limited to
4mg/kg)
enzyme induction may occur with prolonged

high dose therapy
Hypoalbuminemia will result in an increase in
unbound (free) thiopental and an increase in
the potency of thiopental
30 Dec 2015
Pharmacodynamics
19
SODIUM THIOPENTAL
(PENTOTHAL)
-the usual dose is 3-6 mg/kg

- Thiopental should be used with caution
for Patients suffering from shock status
because normal dose may lead to rapid
death
-for a short procedure (e.g.cardioversion)
a dose of 2 mg/kg is generally sufficient
-for frail elderly women with hip fracture .51 mg/kg may induce anesthesia
30 Dec 2015
Dose & administration
20
1- induction of anesthesia
3- control of convulsive states
2- maintenance of anesthesia
for short procedures
30 Dec 2015
SODIUM THIOPENTAL
(PENTOTHAL) INDICATIONS
4- for supplement of regional

anesthesia or low potency
anesthesia
21
SODIUM THIOPENTAL
(PENTOTHAL)
1- airway obstruction
3- previous hypersensitivity
PRECUATIONS
2- porphyria
30 Dec 2015
Absolute contraindications
1- CVS disease
2- severe hepatic disease
3- renal diseases
22
SODIUM THIOPENTAL
(PENTOTHAL)
1- hypotension :if thiopental is administered to
hypovolemic, shocked or previously hypertensive pt
used
3- tissue necrosis : following venous infusion

4- laryngeal spasm
5- bronchospasm :unusual but may be precipitated in
2- respiratory depression :when excessive doses are
30 Dec 2015
SIDE EFFECTS
asthmatics pts
6- allergic reaction : from cutanous rashes to severe

anaphylactic shock with cvs collapse
23
SODIUM THIOPENTAL
(PENTOTHAL)
7- Rarely, intra-arterial injection can occur.
The consequences of accidental arterial injection may be severe.
Treatment consists of
1. dilution of the drug by the administration of saline into the
artery,
2. heparinization to prevent thrombosis, and
3. brachial plexus block.
The degree of injury is related to the concentration of the drug.
30 Dec 2015
SIDE EFFECTS
Overall, the proper administration of thiopental intravenously is

remarkably free of local toxicity.
24
30 Dec 2015
25
Intravenous
anaesthetic/hypnotic.
Akylphenol.
Propofol is a sweet drug
in the OR, but definitely
not for home use.
30 Dec 2015
PROPOFOL
26
PROPOFOL
Emulsion consists of:

10% soyabean oil.
2.25 %glycerol
1.2% purified egg phosphatide.
27
1% propofol 10mg/ml
30 Dec 2015
PHYSICAL AND CHEMICAL

PROPERTIES
PROPOFOL
so Propofol is a highly lipid soluble oil thats combined

with glycerol, egg, and soya bean oil for IV
administration.
Its appearance is similar to that of a 2% milk.
It has a pH of 7 and is supplied in 20 ml ampoules

with a concentration of 10 mg/ml.
Neither precipitates histamine release nor triggers
malignant hyperthermia.
Has no effects on muscle relaxants.
Associated with low incidence of nausea & vomiting.
30 Dec 2015
PHYSICAL AND CHEMICAL

PROPERTIES
28
healthy unpremedicated 2.5-3 mg/kg.
For
premedicated 1.5-2 mg/kg.
Elderly
patients <= 1 mg/kg.
Maintenance
of anesthesia (50-150 mcg/kg/min)
combined with N2O and Opioids (Continuous
For
30 Dec 2015
PROPOFOL
DOSAGE
Infusion: Total intravenous Anesthesia TIVA)

For
IV conscious sedation for operative procedures
with local anaesthesia 25-75 mcg/kg/min.
29
PROPOFOL
Cerebral:
Cardiovascular:
decrease in arterial blood pressure secondary to a
drop in systemic vascular resistance,
contractility, and preload. Hypotension is more
pronounced than with thiopental. Propofol
markedly impairs the normal arterial baroreflex
response to hypotension.
decreases cerebral blood flow and intracranial

pressure. Propofol has antiemetic, antipruritic,
and anticonvulsant properties.
30 Dec 2015
EFFECTS ON ORGAN SYSTEMS
30
PROPOFOL
Respiratory:
Venous irritation:
Pain on injection is more common than with thiopental

esp. if given in a small vein in the hand.
To solve this problem:
propofol causes profound respiratory depression.

Propofol induced depression of upper airway
reflexes exceeds that of thiopental.
30 Dec 2015
EFFECTS ON ORGAN SYSTEMS
1. small doze of lidocaine with propofol.

2. administering propofol through a fast flowing more proximal IV
catheter.
31
Approved Patient Population

Adults only
Adults only
(See PRECAUTIONS)
Patients 3 years of age
Patients 2 months of age
indication
Initiation and maintenance of
Monitored Anesthesia Care
sedation
Combined sedation and regional
anesthesia
Induction of General Anesthesia
Mainenance of General Anesthesia
Intensive Care Unit (ICU) sedation
of intubated, mechanically
ventilated patients
30 Dec 2015
PROPOFOL
INDICATIONS
Adults only
32
1.
2.
4.
3.
Egg allergy.
Lack of resuscitation equipment or
knowledge of the drug.
Inability to maintain a patent airway.
Conditions in which reduction in blood
pressure cant be tolerated. E.g. patients with
fixed cardiac output (severe aortic or mitral
stenosis, IHSS, pericardial tamponade) and
those in shock status.
30 Dec 2015
PROPOFOL
CONTRAINDICATIONS
33
Its a dissociative anesthetic
by dissociative we mean that

the patient is unconscious but
appears awake and doesnt
agent.
30 Dec 2015
KETAMINE
feel pain.
It has anesthetic and

analgesic effect
34
KETAMINE
chemically
Water
soluble, and 10x more lipid

soluble than thiopental.
pH=3.5
- 5.5
related to the psychotropic

drug ( e.g. phencyclidine).
30 Dec 2015
PHYSICAL & CHEMICAL PROPERTIES
35
KETAMINE
: 2mg/kg
IM.
Oral.
Rectal. Needs higher doze due to
extensive first pass metabolism and
decreased absorption.
I.V.
30 Dec 2015
PHARMACOKINETICS
ROUTE OF ADMINISTRATION
36
KETAMINE
5 10 mg/kg. peak plasma level

reach approx 15 minutes
IV
1 2 mg/kg. dissociated stage is

noted in 15 seconds. intense analgesia,
amnesia & unconciousness occur within 4560 minutes
subsequent IV doses of 1/3 of the
initial dose maybe required
IM
30 Dec 2015
PHARMACOKINETICS
DOSAGE
37
Hepatic metabolism is required for elimination

<5% excreted unchanged in urine
It has a rapid absorption and distribution to the

vessel rich groups like THIOPENTAL
30 Dec 2015
KETMINE
METABOLISM
38
There are 3 theories explains the MOA of ketamines :
1 N-methyl aspartate receptor theory :
2 Opiate receptor theory :

Ketamine may have some affinity for opiate receptors but its
effect cant be reversed with naloxone.
3- Miscellaneous receptor theory :
NMA receptors may represent a subgroup of the sigma opiate

receptors (the PCP site) that blocks spinal pain reflexes.
30 Dec 2015
KETMINE
MECHANISM OF ACTION
It reacts with muscarinic, cholinergic and serotonergic receptors.
Ketamine is a potent analgesic at subanesthetic plasma

concentrations.
It has a wide margin of safety ( up to 10x the usual dose )
39
CNS
1. ketamine increases cerebral oxygen

consumption, cerebral blood flow, and
intracranial pressure
2- generalized increase in the muscle tone and
purposful movements.
3- Unpleasant dreams, hallucinations or frank delirium
(esp. females & large doze of ketamine).
incidence of dilirium in 15-35 year old pts is approx.
20%
30 Dec 2015
KETMINE
PHARMACODYNAMICS
40
Respiratory
system:
It preserves laryngeal &pharyngeal airway reflexes.

Ketamine is a potent bronchodilator.
The CO2 response curve is shifted to the left with its
slope unchanged (similar to opiates).
FRC unchaged.
Minute ventilation unchanged.
Tidal volume unchanged.
Hypoxic pulmonary vasoconstriction unchanged.
Ketamine causes increased secretions but this can be
limited by anti-cholinergic drugs.
30 Dec 2015
KETMINE
PHARMACODYNAMICS
41
CVS:
It produces central sympathetic stimulation,

which increases:
1. arterial blood pressure, heart rate, and cardiac
output.
2. Pulmonary artery pressure.
3. Coronary blood flow.
4. Myocardail oxygen uptake.
It may cause myocardial depression if the
sympathetic nervous sys is exhausted or
blocked.
30 Dec 2015
KETMINE
PHARMACODYNAMICS
42
GI
Minimal anorexia, nausea & vomiting.
Placental transfer does occur, but neonatal depression hasnt

been observed if the doze is limited to < 1 mg/kg.
Muscle system
GU
30 Dec 2015
KETMINE
PHARMACODYNAMICS
Generalized increase in skeletal muscle tone.

Increases the effects of muscle relaxants.
Endocrine Sys.
Increased sympathetic stimulation increased blood

glucose, increased plasma cortisol, increased heart rate.
43
1- sole anesthetic for diagnosis and surgical

procedures
3- to supplement regional or local anesthetic

techniques
2- induction of anesthesia
30 Dec 2015
KETMINE
INDICATIONS
4- for anesthetic induction in severe asthmatic pts. Or

patients with cardiovascular collapse requiring
emergency surgery
44
1- lack of knowledge of the drug
3- inability to maintain a patent airways

4- allergy to ketamine
5- history of psychosis
2- lack of resuscitative equipment
30 Dec 2015
KETMINE
CONTRAINDICATIONS
6- cerebro-vascular disease
7- Patients. For whom hypertention is hazardous
45
Features
which result in their

popularity as adjuvant IV anaesthetic
agents:
1 amnesia
2 minimal cardiarespiretory
depressant effect.
3 anticonvulsant activity.
4 low incidence of tolerance and
dependence.
30 Dec 2015
BENZODIAZEPINES
46
1 They inhibit the actions of glycine (by increasing
Benzodiazepines are highly lipid soluble.

They are highly protein bound (albumin).
They are metabolized by the liver through conjugation with
glucoronic acid and excreted by the kidneys.
Midazolam and Diazepam are the most commonly used
benzodiazepines during operative procedures.
the conc. Of a glycine inhibitory neurotransmitter)

which will lead to antianxiety and skeletal muscle
relaxant effects.
2 They facilitate the actions of the inhibitory
neurotransmitter GABA which results in the
sedative and anticonvulsant effects.
30 Dec 2015
BENZODIAZEPINES
MODE OF ACTION
47
They
are commonly used to provide:
2- amnesia.
3- reducing anxiety.
1- IV sedation.
30 Dec 2015
BENZODIAZEPINES
MIDAZOLAM AND DIAZEPAM
48
BENZODIAZEPINES MIDAZOLAM AND

DIAZEPAM
THE DIFFERENCES BETWEEN THEM

30 Dec 2015
1- Midazolam is 2-3 times more potent than

diazepam:
2- The dose for IV conscious sedation: 0.5 3
mg up to 0.1 mg/kg for midazolam, and 1-10
mg for diazepam.
3- The dose for inducing anesthesia: 0.2 0.4
mg/kg for midazolam , and 0.15-1.5 mg/kg for
diazepam.
4- Midazolam has a more rapid onset, greater
amnestic effect, less postoperative sedative
effects than diazepam.
49
BENZODIAZEPINES MIDAZOLAM AND

DIAZEPAM
THE DIFFERENCES BETWEEN THEM

30 Dec 2015
5- Pain on injection and subsequent

thrombophlebitis is less likely with midazolam
(an emulsion of diazepam)
6- Midazolam is more costly than diazepam).
7- Midazolams duration of action is less than
diazepam but almost 3 times that of thiopental.
8- Elimination half time for midazolam range from
1-4 hours, and for diazepam from 21-37 hours.
9- Midazolam is supplied as a clear liquid in
concentrations of 1-5 mg/ml.
50
BENZODIAZEPINE ANTAGONISTS
(FLUMAZENIL)
Its an imidazobenzodiazepine.
It specifically antagonizes benzodiazepines central
Its elimination half-time is one hour, considerably less

than most benzodiazepines; therefore we will need
effects by copetative inhibition.
30 Dec 2015
repeated administrations of flumazenil to antagonize a

benzodiazepine with a longer half-time.
51
30 Dec 2015
BENZODIAZEPINE ANTAGONISTS
(FLUMAZENIL)
Flumazenil is supplied as a colourless liquid in a
concentration of 0.1 mg/ml.
The usual initial dose is 0.2 mg over 15 seconds,
if the desired level of consiousness is not
obtained within one minute of administration we
can give repeated doses of 0.1 mg every minute
up to the maximum of 2 mg, and if sedation
recurs we can use infusions of 0.1-0.4 mg/hour.
Flumazenil is well tolerated.
The most common side is nausea (4% of
patients).
52
NARCOTIC AGONISTS
derived
from dried juice of
poppy plant which
contains over 20
plant alkaloids.
including morphine
& codiene.
30 Dec 2015
Opium
53
NARCOTIC AGONISTS
SITE OF ACTION
30 Dec 2015
Opioid receptors are predominantly located in the:

1. Brain stem (amygdala, corpus striatum,
periaqueductal gray matter and medulla).
2. Spinal cord(substantia gelatinosa).
3. GIT.
They act on 3 types of receptors:
1. Mu receptors (): analgesia, respiratory
depression, euphoria, & physical dependence.
2. Kappa receptors (K): analgesia, sedation,
respiratory depression, miosis.
3. Segma receptors(a): dysphoria, hallucination,
tachypnea, tachycardia.
54
Rapid
distribution through the body
Its
metabolized by the liver and the
majority of the inactive metabolites are
following IV injection.
30 Dec 2015
NARCOTIC AGONISTS
PHARMACOKINETICS
excreted unchanged in the urine.

55
CNS:
Opioids sedate through interfering with

sensory perception of painful stimuli.
large doses produce unconsciousness but
they are generally incapable of producing
anesthesia and it cant guarantee total
amnesia.
It may produce nausea & emesis through
stimulation of the chemoreceptor trigger
zone.
30 Dec 2015
NARCOTIC AGONISTS
PHARMACODYNAMICS
56
Respiratory
result in dose related depression
of respiratory rate and minute
ventilation and increase the tidal
volume which will lead to a slow deep
respiration. Reversed by naloxone
administration.
They
30 Dec 2015
NARCOTIC AGONISTS
PHARMACODYNAMICS
57
NARCOTIC AGONISTS
PHARMACODYNAMICS
Opioids
have little myocardial depressant effect even

when administered in high doses.
Supplementation with either N2O or benzodiazepines
may depress cardiac output.
They decrease systemic vascular resistance either by
decreasing sympathetic outflow or by releasing
histamine (as morphine) which produces vasodilation
& decrease SVR.
Synthetic opioids are less likely to release histamine.
They produce bradycardia by stimulation vagal
nucleus in the brain stem.
30 Dec 2015
CVS
58
NARCOTIC AGONISTS
PHARMACODYNAMICS
Narcotics
Others
Increases
slow GI mobility and may result in

constipation or post operative ileus.
All narcotics increase biliary tract tone which
may lead to biliary colic with patients with bile
stones.
30 Dec 2015
GIT
the bladder sphincters tone urine
retention.
Anaphylactic reactions, bronchospasm, chest
wall rigidity and pruritis.
59
Fentanyl
30 Dec 2015
NARCOTIC AGONISTS
FENTANYL AND MORPHINE
is the most narcotic agent used

during induction of anaesthesia due to its
rapid onset (highly lipid soluble) and
predictable duration of action (30
minutes).
Morphine is used in the perioperative
period to provide long lasting analgesia.
And it should be administered slowly at a
rate < 5 mg/min to avoid excessive
60
histamine release.
Analgesic dose
Low dose
Morphine
mg 10
0.05 - 0.2 mg/kg
Fentanyl
100
mcg 100
mic g/kg 3 0.5
Potency Ratio
30 Dec 2015
NARCOTIC AGONISTS
FENTANYL AND MORPHINE
61
NARCOTIC ANTAGONISTS
(NALOXONE)
Naloxone competes with opioids at the mu, delta,
Ampules of 0.02, 0.4 and 1 mg/ml.
Peak effect 1-2 min.
Duration of action 30-60 min.
Used in perioperative surgical patients with excessive
kappa and sigma receptors.
30 Dec 2015
sedation or respiratory sedation secondary to

opioids.
62
Given
in small incremental doses.

High doses of naloxone will result in sudden
reversal of analgesic effects leading to abrupt
return of pain resulting in hypertension,
tachycardia, pulmonary edema, ventricular
dysrhythmias and cardiac arrests.
If sedation or respiratory depression recurs,
continuous infusion of 3-10 micg/kg/hour of
naloxone is required.
30 Dec 2015
NARCOTIC ANTAGONISTS (NALOXONE)
63
30 Dec 2015
ANAESTHESIA
THANK YOU
64
65

Department of Anesthesiology - Jordan University of Science and Technology Irbid-Jordan
Thank you
30 Dec 2015
INTRAVENOUS
ANAESTHETIC
AGENTS

Intravenous Anesthetic Agents-1

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Department of Anesthesiology - Jordan University of Science and

Dr. Med. Khaled Radaideh

Dr. Med. Khaled Radaideh

INTRA VENOUS ANAESTHETIC AGENT

Dr. Med. Khaled Radaideh

1- Properties of the ideal intravenous anesthetic agent

INTRA VENOUS ANAESTHETIC AGENT

Dr. Med. Khaled Radaideh

INTRA VENOUS ANAESTHETIC AGENT

Dr. Med. Khaled Radaideh

6.4. Benzodiazepine antagonists (Flumazenil)

PROPERTIES OF THE IDEAL INTRA

Dr. Med. Khaled Radaideh

1-rapid onset: achieved by an agent that is mainly :

3- analgesia at sub anesthetic concentrations

PROPERTIES OF THE IDEAL INTRA

Dr. Med. Khaled Radaideh

4- minimal cardiovascular and resp. depression

16-no stimulation of porphyria

Dr. Med. Khaled Radaideh

The length of time a product may be stored without becoming unsuitable

PROPERTIES OF THE IDEAL INTRA VENOUS

Dr. Med. Khaled Radaideh

ultra short acting barbiturate

Dr. Med. Khaled Radaideh

Sodium thiopental (pentothal)

Dr. Med. Khaled Radaideh

-Its stable at room temp for 2 weeks

Thiopental is a core medicine in the World

-time required to render the patient unconscious

Dr. Med. Khaled Radaideh

-An IV dose of 3-5 mg/kg results in loss of

-arm brain circulation time

Sodium thiopental (pentothal)

So is most commonly used in the

Dr. Med. Khaled Radaideh

no other drugs ,the anesthetic

Sodium thiopental (pentothal)

-liver &renal disease may be associated with low albumin levels

Dr. Med. Khaled Radaideh

-sulphur containing drugs , acidosis, NSAIDS may displace

-a desulfuration rxn in liver produces pentobarbital which under goes

-thiopental will decrease both cerebral electrical & metabolic activity

Dr. Med. Khaled Radaideh

altering the duration they spend in an open state

thiopental BUT The improvement of ICP requires high

Dr. Med. Khaled Radaideh

CNS: Elevated ICP can quickly be reduced by

Intraocular pressure decreases

up to 25% with 3-5mg/kg of thiopental and persists for

of myocardial function as measured by CO,SV, and

Dr. Med. Khaled Radaideh

CVS:-thiopental causes a dose related depression

-FRC is reduced by 20% with induction of

Dr. Med. Khaled Radaideh

-laryngospasm and bronchoconstriction may

- Thiopental has little or no effect on the kidneys

Dr. Med. Khaled Radaideh

enzyme induction may occur with prolonged

Dr. Med. Khaled Radaideh

-the usual dose is 3-6 mg/kg

Dose & administration

3- control of convulsive states