Drugs used in

Anaesthesia

Dr. Vasanthi Pinto

(MD, FRCA, FRACSI)
Consultant Anaesthetist
Components of Anaesthetics
LOC

Muscle
relaxation Analgesia

Each of these can be varied without affecting the

other two by using selective drugs
Core Drugs in Anaesthetic
Practice
 Intravenous Anaesthetics
 Inhaled Anaesthetics and O2
 Analgesics
 Local Anaesthetics
 Muscle relaxants and its reversal
Anticholinesterase
 Other Drugs
Intravenous Anaesthetics

 Agents that induce loss of consciousness

in one arm brain circulation time
 Induce Anaesthesia reliably and pleasantly
IV Induction Agents

Barbiturates Non Barbiturates

Eg:Thiopentone Etomidate
Sodium Propofol
Benzodiazepine-
midazolam
Ketamine
Thiopentone Na
 Induce in one arm brain circulation time
 No analgesic activity
 Rapid recovery
 Complete metabolism and excretion take
24 hrs
 Intra arterial injection causes severe
vasospasm and gangrene
Mechanism of Action

Act through GABA dependant Cl Channel

Opening in the

Hyperpolarization
“neuronal inhibition”
Pharmacological Properties

 Rapid onset
 High lipid solubility
 Rapid recovery
Adverse reactions

 Histaminerelease
 Anaphylactic reaction
 TPS Propofol Ketamine Mida
CVS BP
CO
HR
R/S RR
ICP
Dose 3-5 2mg/kg 2mg/kg
mg/kg
Propofol
 Onset and recovery is rapid and
predictable
 Rapid clearance
 Can use as infusion or as TIVA( Total
Intravenous Anaesthesia)
Inhaled Anaesthetics
 N2O
 Volatile Anaesthetics
 Halothane
 Isoflourane
 Enflourane
 Sevoflourane
 Desflourane

 Chloroform, Ether, Trichloroethylene,

Cyclopropane
 Like dose in IV agents =
Inhalation agents -MAC

(Minimal Alveolar Concentration)

Eg. MAC of Halothane – 0.75
Common Features
 High oil gas permeability
 Not metabolized or least metabolized
 Non toxic
 Pleasant order
 Atmospheric friendly – non flammable
 Cheap
 Effects – “All are myocardial
depressants”
Halothane Isoflorane Sevoflorane

BP
Contractility

SVR
HR Nil
Cardiac Preserved
Output
Important Points
•N2O – Megaloblastic changes in the bone
marrow, reduce DNA synthesis
•Halothane –Cardiac irritability
Liver toxicity with hepatic damage
•Isoflorane – Maintains cardiac out put
•Sevoflourane – Ideal for children
minimal side effects
•New agent - Xenon
Oxygen
 Part of all Anaesthetic techniques
 Minimum during anaesthesia – 33%
 High risk patients and children needs
higher %
 Analgesics
Opioids and related drugs

 Morphine – 0.1mg/kg
 Pethidine – 1mg/kg
 Fentanyl - 1µg/kg
 Alfentanil ,Sufentanyl & Remifentanil
 Tramadol
Act on opioid receptor
 Problems
- Respiratory depression
- Histamine release
- Bradycardia
- Pruritus
- Nausea & vomiting
- Urinary retention
- CNS - sedation
Non steroidal Anti inflammatory
drugs
NSAIDS

- Inhibit PG synthesis
Bad effects
- Gastric irritation
- NSAIDS sensitive asthma
- Renal function - reduced
- platelet function - reduced
Muscle relaxants
Neuro muscular junction
Action potential

Ach release

Opening of Na/K+ channel

muscle contraction
Muscle relaxants

Depolarising
Non depolarizing
Eg. Suxamethonium
Eg. Atracurium
“short acting”
Vecuronium
Pancuronium
“long acting”
Depolarizing mechanism
-Suxamethonium mimic action of Ach

-Binds to Ach receptor

-But no enzyme to metabolize quickly
-Therefore prolong opening of channels

Muscular relaxed
Uses: relax the vocal cord muscle for intubation
Action lasts 5-10 minutes
Non depolarising

Binds competitively to Ach receptor

Ach cannot bind to its receptor and cause
muscle contraction
Eg. Atracurium,Vecurorium

Uses: prolonged surgeries which needs muscle

relaxation
Eg. Laparotomy
End of surgery needs to reverse the muscle relaxation

Anticholinesterases Reversal of muscle relaxation

Normally Ach metabolized by Ach Esterase enzyme

If block Ach Esterase enzyme more Ach available

Can compete with the muscle relaxant and displace the muscle
relaxant and initiate contraction Eg. Neostigmine
 LOC IV
Inhaled

Analgesia Muscle relaxation

Opiates
NSAIDS Depolarise Non Depolarise

LA “Long”
“Short”
Reverse by
anticholinesterases
Local Anaesthetics
 Reversible inhibition of transmission of
nerve impulses
 Impede inward flow of Na+ ions and
prevent propagation of nerve impulse
 Drug in the vicinity of pain receptors,
nerves, nerve plexuses, ganglia, spinal
cord and roots in the subarachnoid space
or extramural space
 Procaine
 Cocaine
 Lignocaine
 Prilocaine
 Bupivacaine
 Ropivacaine
Toxicity of Local Anaesthetic agents

 Due to – Overdose, Rapid absorption from

a vascular site, Inadvertent IV injection,
Anaphylaxis
 Effects are seen in CNS and CVS
 CNS -Restlessness, numbness of tongue,
dizziness,tinnitus,convulsions
 CVS – Tachycardia,Hypotention,cardiac
arrest
 Respiratory arrest
 Anaphylaxis
 Dermal urticaria
 Angioneurotic oedema
 Bronchoconstriction
QUESTIONS ?