‫ ساليدز‬13 ‫غير شامل اول‬
IV Agents
A.
Barbiturates:
Thiopentone
B.
OPIOIDS
C.
Benzodiazepine
-Ultra-short acting
hypnotic with no
analgesic action
-High lipid solubility
promotes rapid entry to
the brain
-Eliminated by the liver
-Has rapid onset of action
and recovery
Morphine and fentanyl
are used in anesthesia
regimens.
-Respiratory depression
due to these drugs may
be reversed by naloxone
Midazolam is widely
used adjunctive with
inhaled anesthetics and
IV opioids
-It has slow onset and
longer duration of action
if compared to
thiopental.
Flumazenil is an antidote
if respiratory depression
occur.
Mechanism of
action:
Pharmacokinetics
Act at cell surface
receptors:
-Barbiturates and
benzodiazepine
act at GABA-A
receptors to
increase Cl- influx
-Opioids act on μ
and other
subtypes
-Ketamine
antagonizes PCP
site on NMDA
receptors (prevent
excitation)
Potentiates GABA,
decrease
glutamate activity,
increase chloride
ion conductance
-Rapid induction =
shorter acting
Adverse reactions:
-Duration of effect
proportional to
redistribution from
brain to other
tissue
Decreased
myocardial and
respiratory activity
D.
Miscellaneous
Agents
1. Etomidate
non-barbiturate
hypnotic agent
without analgesic
properties
2. Ketamine
dissociative
anesthetic
3.Propofol
-Imidazole derivative that
provide induction with minimal
change in cardiac function and
respiratory rate and has short
duration of action
-It is not analgesic , and its
primary advantage is in
anesthesia for patient with
limited respiratory and cardiac
reserve
-This drug produce dissociative
state in which the patient is
patient remains conscious but
has marked catatonia,
analgesia, and amnesia
-It is a chemical congener of
the psychotomimetic agent,
phencyclidine (PCP)
-It is a cardiovascular stimulant
drug
-Can cause increase
intracranial pressure
-Emergency reactions include
disorientation, excitation and
hallucination which can be
reduced by preoperative
administration of
benzodiazepine
Mechanism Uses
of action:
Side effects
Activates
GABA
receptors
-Myoclonus
-Post-operative
nausea and
vomiting
-Adrenal
suppression if
prolonged use.
Induction of
anesthesia
-in children
-in severely
hypovolemic
patients
-Induction
and
maintenance
of anesthesia
-As anesthetic
agent at
outpatient
surgery
-Also effective
in producing
prolong
sedation in
patient in
critical care
setting
Contraindications
-Increased
intracranial
pressure
-Ischemic heart
disease
-Psychological
disorders
-Hypnosis ,
Antiemetic
-Fast acting,
short duration.
Cardiovascular
instability due to
marked reduction
in the peripheral
resistance
-Fewer
peripheral side
effects
compared to
barbiturates
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