1. Stages
1.1. induction
1.2. maintenance
1.3. recovery
2. Types
2.1. A)inhalational
2.1.1. gases e.g N2O
2.1.2. volatile liquids e.g..halothane
2.1.3. MoA
2.1.3.1. 1) enhance GABAa receptors to GABA
2.1.3.2. 2) stimulate glycin receptors activity
2.1.3.3. 3) block postsynaptic excitatory current.
2.1.4. important principles
2.1.4.1. MAC--if low-->hihgly potent halothane,isoflurane.
2.1.4.2. oil-gas partition----> if high--->more lipid soluble----more potent...halothane, isoflurane
2.1.4.3. blood-gas partion...if low---> less soluble in blood---> good for induction---> nitrous oxide, desflurane.
2.1.5. elimination
2.1.5.1. most by lungs
2.1.5.2. more soluble---takes tome to be eliminated
2.1.6. A.E
2.1.6.1. cardiac and respiratory depresiion
2.1.6.2. Hepatotoxicity
2.1.6.3. sensitization of catecholamines to heart
2.1.6.4. Malignant hyperthermia.
2.1.6.4.1. give dantrolene to reduce Ca2+ flux.
2.2. B) intravenous
2.2.1. Propofol
2.2.1.1. induction ( less than 60sec)
2.2.1.2. maintanance
2.2.1.3. A.E
2.2.1.3.1. Pain
2.2.1.3.2. hypotension
2.2.1.3.3. resp. depresion
2.2.1.3.4. propofol infusion syndrome ( at high doses)
2.2.2. Ketamine
2.2.2.1. Benefits
2.2.2.1.1. analegsia
2.2.2.1.2. stimulate sympathetic
2.2.2.1.3. minimal resp. depression
2.2.2.1.4. bronchodilation
2.2.2.2. Dissociative anesthesia
2.2.2.3. produce hallucinations and disturbing dreams ----give benzodiazepines as premedication
2.2.2.4. indications
2.2.2.4.1. minor surgical and diagnostic procedure
2.2.2.4.2. changing burn dressing.