An Introduction to Anaesthesia 20

ANAESTHESIA DRUGS
Dr. Su Cheen Ng
Consultant in Anaesthesia
UCLH

TODAYS TALK
Principles to drugs
What we hope to achieve with
anaesthesia
Maintenance of anaesthesia
Muscle relaxants
Reversal agents for muscle relaxants
Uppers and Downers
Analgesia
Antiemetic- anti nausea/vomiting

Introduction - Principles
Pharmacokinetics
- What the body does to the drug
- Absorption, distribution, metabolism, elimination
Pharmacodynamics
-What the drug does to the body ie its
effects / Side effects
-CVS, RS, GI, NS, Other

Objectives of Anaesthesia
Loss of awareness / Amnesia

If Warranted:
Analgesia
Suppression reflex /Reduce movement in
response to stimuli
Minimize autonomic responses to surgical
stimuli
Skeletal Muscle relaxation

TRIAD

What is Balanced
Anesthesia?
No single drug is capable of achieving all of the
desired goals of anesthesia.
SIDE EFFECTS

TOXICITY

Balanced Anaesthesia - A combination

of agents, to
limit the dose and toxicity of each drug

NOTE
General anesthesia (GA)
-uses intravenous and inhaled agents to
allow adequate surgical access to the
operative site.
GA may not always be the best choice;
depending on a patients clinical
presentation!

THE GENERAL FLOW of GA

Intravenous induction- e.g. propofol, thiopentone

Short acting opiate - e.g. fentanyl

Muscle paralysis may be needed

Airway device

Set up of anaesthetic maintenance inhaled or

gasses (e.g. sevoflurane vapour in oxygen and air)

Others: Analgesia: IV, local anaesthesia, Antiemetic

IV INDUCTION AGENT
Used alone or with other drugs to:
Achieve general anesthesia
As components of balanced anesthesia
To sedate patients
Examples:
Barbiturates : thiopentone
Propofol
Ketamine
Etomidate

PROPOFOL
- INDUCTION and MAINTENANCE of
anaesthesia
- Sedative, anaesthetic, amnesic, anticonvulsant,
- Solvent :10% soyabean oil, 2.25% glycerol,
1.2% egg phosphatide
- Rapid onset and short duration
- Causes hypotension due to vasodilatation.
- Pain on injection common especially small hand
veins

MAINTANENCE of
ANAESTHESIA
Most Commonly : Inhalation Agents (OR
IV agents)
Ie: SEVOflurane, ISOflurane, DESflurane
Inhaled and
Alveoli
Exhaled
gases
Path of Equilibrium of inhaled agents

Blood

CNS

Minimum alveolar concentration (MAC) = Measure

of POTENCY
1 MAC= the concentration that results in
immobility in 50% of patients when exposed to
standardized skin incision

In combination
with:
- Air
- Oxygen

MUSCLE RELAXANTS
Indication
-Tracheal intubation
-Surgical relaxation
-Control of ventilation

Muscle Relaxants-Types
Side Effects

Depolarizing
muscle relaxant

-bradycardia
-muscle ache

Suxamethonium

-nausea

Rapid sequence
Intubation

-increase K+ level
-suxamethonium apnoea

Does NOT provide ANALGESIA or

SEDATION/UNCONSCIOUNESS

Muscle Relaxants-Types
Nondepolarizing muscle relaxants
Short acting: Mivacurium
Intermediate acting: Atracurium,
Cisatracurium, Vecuronium,
Rocuronium
Long acting: Pancuronium
Does NOT provide ANALGESIA or
SEDATION/UNCONSCIOUNESS

Reversal of NDMB
Neostigmine
Increase Ach concentration
SE: Slows HR, paristalsis
Given with an anticholinergic
Sugammadex
-different doses based on
indication: routine versus
emergency

UPPERS AND DOWNERS

INCREASE BP
- adreno-receptor agonists: Metaraminol,
Phenylephrine
- Mixed and adreno agonist:Ephedrine
LOWER BP
- more anaesthetic agent or opiate,
- short acting -blockers- labetalol,esmolol
- GTN
- 2 agonist: clonidine

ANALGESIC
Systemic (PO/IV/ PR/ SC)

Simple- Acetaminophen

NSAID Diclofenac, Ibuprofen,coxibs

Opioids - Codeine, Morphine

Others Ketamine, clonidine

Regional spinal / epidural / peripheral nerve blocks

Local infiltration of local anaesthesia

ANALGESIC LADDER

NSAIDS= nonsteroidal anti-inflammatory drugs(ie:

ibuprofen, coxibs, mefenamic acid)

ANTI-EMETIC

Postoperative nausea and vomiting (PONV- any nausea,

retching, or vomiting occurring during the first 2448 h
after surgery

INCIDENCE: 30% in all post-surgical patients, up to 80% in

high-risk patients

ANTI-EMETIC

cyclizine

SUMMARY

TITRATION is key!!

Can always give more cannot take away

Caution in

Unwell

Elderly

Hypovolaemic

Lots of ways to anaesthetise- dont worry

Ask for HELP

Pocket references

THANK YOU