Presented By Manish Ranjan Singh

Anaesthesia : Basic & Types

Induction Maintenance Emergence Types of Anaesthesia

History : Anaesthetic Agents Neuromuscular Blocking Agents

Non-Dipolarizing Agents Dipolarizing Agents

Cisatracurium(Nimbex) Cisatracurium vs Atracurium References

It is a state of unconsciousness The major components of anaesthesia are hypnosis, analgesia, amnesia and immobilization
Hypnosis : loss of consciousness Analgesia : loss of response to Pain Amnesia : loss of Memory Immobilization : loss of motor reflexes

Different Phases of anaesthesia includes:

Induction Maintenance Emergence

Induction
It refers to delivering the anaesthetic agent into human body for purposeful sedation Anaesthetic agents may be administered by various routes, including inhalation, injection, oral, and rectal Onset of anaesthesia is faster with intravenous injection than with inhalation Commonly used intravenous induction agents include propofol, sodium thiopental and ketamine. Sevoflurane is currently the most commonly used anaesthetic agent for inhalational induction

Maintenance
In order to prolong anaesthesia for the required duration, anaesthesia must be maintained Usually this is achieved by controlled mixture of oxygen, nitrous oxide, and a volatile anaesthetic agent or by controlled infusion of medication, usually propofol, through an intravenous system.

Emergence
Emergence is the process of return to baseline physiologic function of all organ systems after the successful administration of general anaesthetic agents.

Anaesthesia

General Anaesthesia

Regional Anaesthesia

Inhalation (VIMA)

Intravenous (TIVA)

Local Anaesthesia

Spinal Anaesthesia

Epidural Anaesthesia

Peripheral Nerve Block

1844 : Nitrous Oxide(N2O) 1846 : Diethyl Ether 1887 : Chloroform 1929 : Cyclopropane 1932 : Use of IV anaesthetic, Thiopentone 1956 : New Generation anaesthetic, Halothane 1990 : Volatile anaesthetic agent, Sevoflurane (most commonly used anaesthetic agent currently)

This blocks neuromuscular transmission and causes paralysis of the muscle. Neuromuscular blocking agents are used as an adjunct to anesthesia Neuromuscular blocking agents are used in the ICU setting for 3 reasons:
to eliminate spontaneous breathing and promote mechanical ventilation Cause a pharmacologic restraint so patients do not harm themselves To decrease oxygen consumption.

Neuromuscular Blocking Agent(NMB) is categorized into two parts:

Non-Depolarizing Agents Depolarizing Agents

Non-Depolarizing : A neuromuscular non-depolarizing

agent is a form of neuromuscular blocker that does not depolarize the motor end plate. These agents constitute the majority of the clinically-relevant neuromuscular blockers. They act by competitively blocking the binding of ACh to its receptors.
Eg. Mivacurium, Vecuronium, Atracurium, Cisatracurium

Depolarizing : These agents act by depolarizing the

plasma membrane of the skeletal muscle fiber. A depolarizing neuromuscular blocking agent is a form of neuromuscular blocker that will depolarize the motor end plate.
Eg. Succinylcholine

Agent (TradeName) Onset Of Action Duration Of Action

Short Acting Agents
Mivacurium (Mivacron) 2.5 min 15 - 20 min

ED90-95 (mg/kg)

0.07

Rapacuronium (Raplon)
Rocuronium (Zemuron) Succinylcholine Atracurium (Tracrium) Cisatracurium(Nimbex) Pancuronium (Pavulon)

Mean: 1.5 min (35 - 219 sec)

1 - 3 min 0.5 - 1 min 2.5 - 5 min 2 - 3 min 2 - 3 min

Mean: 15 min (6 - 30 min)

31 min (15 - 85 min) 5 - 8 min 20 - 45 min 30 - 40 min 60 - 90 min

1.03
0.3 0.3 0.2 0.05 0.06

Intermediate Acting Agents

Vecuronium (Norcuron)
Doxacurium (Nuromax) Pipecuronium (Arduan)

2 - 3 min
6 min (2.5 - 13) 2.5 - 5 min

25 - 40 min
100 min (39 - 232) 75 min (35 - 175)

0.05
0.025 0.07

Long Acting Agents

Tubocurarine

3 - 5 min

70 - 90 min

0.05

It is a skeletal muscle relaxant in the category of nondepolarizing neuromuscular-blocking drugs. It is used adjunctively in anesthesia to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation It is intermediate in its onset and duration of action Cisatracurium is one of the ten isomers of the parent molecule, atracurium and represents approximately 15% of the atracurium mixture

Cisatracurium causes less histamine release than atracurium Cisatracurium has a slightly slower onset of action than its parent molecule, atracurium. Metabolism of both atracurium and cisatracurium produce laudanosine as metabolite but cistracurium produces very less amount metabolite. Therefore any risk associated with the laudanosine would seem to be even less with cisatracurium than atracurium. Cisatracurium is three times more potent than atracurium, hence lower doses are required

www.generalanaesthesia.info www.drugs.com www.wiki-meds.com www.druglib.com en.wikipedia.org Medical journals