1. IV Induction agent
1.1. Definition
1.1.1. Agents that will induce loss of consciousness in one arm-brain circulation time
1.2. Ideally
1.2.1. Rapid onset
1.2.2. Rapid recovery, no accumulation
1.2.3. Analgesic effect
1.2.4. No toxic effects
1.3. Agents
1.3.1. Phenolic derivative
1.3.1.1. Propofol
1.3.1.1.1. Can be used induction and maintenance
1.3.1.1.2. Drop in systemic vascular resistance
1.3.1.1.3. Respiratory depression
1.3.1.1.4. Anti emetic
1.3.2. Barbiturates
1.3.2.1. Thiopental
1.3.2.1.1. Dose dependent reduction in cardiac output
1.3.2.1.2. Dose dependent respiratory depression
1.3.2.1.3. Contraindicate in porphyria patients
1.3.3. Pheycyclidine derivative
1.3.3.1. Ketamine
1.3.3.1.1. Maybe given IV, IM
1.3.3.1.2. Produces symphatetic stimulation
1.3.3.1.3. Increase RR, laryngeal reflex preserved
1.3.3.1.4. Dissociative anaesthesia
1.3.3.1.5. Not in one arm-brain circulation
1.3.3.1.6. Vivid dreams, hallucinations, delirium
1.3.4. Imidazole derivative
1.3.4.1. Etomidate
1.3.4.1.1. Least CVS disturbances
1.3.4.1.2. Supresses adrenocortical function
1.3.5. Benzodiazepines
1.3.5.1. Midazolam
2. Inhalational agent
2.1. Volatile agents
2.1.1. Usage
2.1.1.1. Reversible loss of consciousness
2.1.1.1.1. inhalational induction
2.1.1.1.2. maintenance of anaesthesia
2.1.1.2. Loss of response to noxious stimuli
2.1.2. Mechanism of action
2.1.2.1. Molecular theory
2.1.2.1.1. membrane lipids
2.1.2.1.2. GABA A receptor
2.1.2.1.3. Glycine receptor
2.1.3. Minimum alveolar concentration (MAC)
2.1.3.1. Measure of potency
2.1.3.2. MAC at steady state that prevents reaction to a standard surgical stimulus in 50% of subjects at one atmosphere
2.1.4. Ideally
2.1.4.1. Inert when in contact with meta, rubber
2.1.4.2. Not flammable
2.1.4.3. Pleasant odor
2.1.4.4. Only affects CNS
2.1.4.5. Analgesic properties
2.1.5. Examples
2.1.5.1. Halothane
2.1.5.1.1. Hepatic damage
2.1.5.2. Isoflurane
2.1.5.3. Desflurane
2.1.5.3.1. Irritating smell
2.1.5.3.2. Cannot be use for inhalational induction
2.1.5.4. Sevoflurane
2.1.5.4.1. Pleasant, sweet odor
2.1.5.4.2. can be use for inhalational induction
2.2. Nitrous oxide
2.2.1. Maybe used alongside volatile agents, faster loss consciousness
2.2.2. Entonox: 50/50combination with O2
2.2.3. analgesic effect
2.2.4. Nausea vomitting
3. Local anaesthetics
3.1. Usage
3.1.1. Neuroaxial block
3.1.2. Regional block
3.1.3. Treat arrhythmia
3.2. Mechanism of action
3.2.1. Blockade of the Na channel
3.2.2. More lipid solubility more potent
3.3. Agents
3.3.1. Amide
3.3.1.1. Lignocaine
3.3.1.2. Bupivacaine
3.3.1.3. Ropivacaine
3.3.2. Ester
3.3.2.1. Procaine
3.3.2.2. Amethocaine
3.3.2.3. Cocaine
3.4. Preparations
3.4.1. Water soluble
3.4.2. Additives includes preservatives, adrenaline, felypressin
3.5. Effects
3.5.1. Block transmission of action potential
3.5.2. Vasodilator activity
3.5.3. Ineffective when used to anaesthetise infected tissue
3.5.4. Direct myocardial depressant effect
3.5.5. Local anaesthetic systemic toxicity
4. Analgesia
4.1. Opioids
4.1.1. Examples
4.1.1.1. Morphine
4.1.1.1.1. respiratory depression
4.1.1.1.2. nausea and vomitting
4.1.1.1.3. sedation, euphoria, dysphoria
4.1.1.1.4. bradycardia, hypotension
4.1.1.1.5. urinary retention
4.1.1.1.6. constipation
4.1.1.1.7. histamine release
4.1.1.2. Fentanyl
4.1.1.2.1. less likely antihistamine release
4.1.1.2.2. bradycardia
4.1.1.2.3. short duration of action
4.1.1.3. Codeine
4.1.1.3.1. less potent, not suitable for severe pain
4.1.1.3.2. histamine release
4.1.1.3.3. have antitussive effect
4.1.1.4. Tramadol
4.1.1.5. Remifentanil
4.1.1.5.1. ultrashort duration of action
4.1.1.5.2. infusion
4.1.1.5.3. TIVA
4.1.2. Acts at opioid receptor: mu, kappa, delta, NOP
4.2. Non opioids
4.2.1. NSAID
4.2.1.1. Examples
4.2.1.1.1. Non specific COX inhibitors
4.2.1.1.2. Specific COX-2 inhibitors
4.2.1.2. Mechanism of action
4.2.1.2.1. inhibit enzyme cyclooxygenase, preventing production of prostaglandins and thromboxanes
4.2.1.3. Side effects
4.2.1.3.1. gastric irritation
4.2.1.3.2. vascular events eg stroke, MI
4.2.1.3.3. bronchospasm
4.2.1.3.4. kidney failure
4.2.1.3.5. antiplatelet
4.2.2. Anticonvulsants
4.2.2.1. gabapentin
4.2.2.2. pregabalin
4.2.3. Local anaesthetics
4.2.4. Ketamine
4.2.5. Magnesium
4.2.6. Alpha 2 blocker
4.2.6.1. dexmetomidine
4.2.7. Tricarboxylic acids
4.2.7.1. amytriptyline
5. Muscle relaxant
5.1. Usage
5.1.1. profound muscle relaxation for intubation
5.1.2. maintenance muscle relexation during surgery and ventilation
5.2. Mechanism of action
5.2.1. acts at neuromuscular junction
5.3. Depolarizing
5.3.1. mimics the action of ACh by attaching to the nicotinic ACh receptor and causing membrane depolarisation
5.3.2. Suxamenthonium
5.3.2.1. profound muscle relaxation
5.3.2.2. short duration duration, achieve rapidly
5.3.2.3. can be use for RSI
5.3.2.4. other effects
5.3.2.4.1. arrhythmias
5.3.2.4.2. hyperkalemia
5.3.2.4.3. myalgia
5.3.2.4.4. malignanty hyperthermia
5.4. Non depolarizing
5.4.1. by binding competitively to the α subunit of the nicotinic ACh receptor
5.4.2. Aminosteroid
5.4.2.1. Vecuronium
5.4.2.2. Pancuronium
5.4.2.3. Rocuronium
5.4.2.3.1. intermediate acting
5.4.2.3.2. can be used for RSI
5.4.2.3.3. prolonged action in liver and kidney failure
5.4.3. Benzylisoquinolinium
5.4.3.1. Atracurium
5.4.3.1.1. intermediate acting
5.4.3.1.2. produce histamine release
5.4.3.1.3. non organ dependent elimination
5.4.3.2. cisatracurium
5.4.3.3. Mivacurium