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What choices of anesthesia are available? What essential resources are required to induce general anesthesia? How would you induce general anesthesia? What is the volume and dose? Why do we need to do endotracheal intubation during general anesthesia? What drugs will be utilized to give anesthesia? How do you induce general anesthesia? What is the difference between sleep, general anesthesia, and coma? What is the most common general anesthesia available? What choices of anesthesia are available? General anesthetics Local anesthetics General anesthetics Inhalational anaesthetic Desflurane Enflurane Halothane Isoflurane Methoxyflurane Nitrous oxide Sevoflurane Xenon (rarely used) Intravenous agents (non-opioid) Barbiturates
Methohexital (Brevital) Thiamylal (Surital) Thiopental (Penthothal, referred to as thiopentone in the _______)
Lorazepam Midazolam Ketamine Propofol Intravenous opioid analgesic agents Alfentanil Fentanyl Remifentanil Sufentanil The following agents have longer onset and duration of action and are frequently used for post-operative pain relief: Buprenorphine Butorphanol diacetyl morphine, (Diamorphine, also known as heroin, not available in _______) Hydromorphone Levorphanol Meperidine, also called pethidine in the ________ Methadone Morphine Nalbuphine Oxycodone, (not available intravenously in ______) Oxymorphone Pentazocine Muscle relaxants Depolarizing muscle relaxants Succinylcholine (also known as suxamethonium in the _______) Decamethonium Non-depolarizing muscle relaxants Short acting Mivacurium Rapacuronium Intermediate acting Atracurium Cisatracurium Rocuronium Vecuronium Long acting Alcuronium Doxacurium Gallamine Metocurine Pancuronium Pipecuronium Tubocurarine Intravenous reversal agents Flumazenil, reverses the effects of benzodiazepines Naloxone, reverses the effects of opioids Neostigmine, helps reverse the effects of non-depolarizing muscle relaxants Sugammadex, new agent that is designed to bind Rocuronium therefore terminating its action Local anesthetics Each of the local anesthetics have the suffix "-caine" in their names. procaine amethocaine cocaine lidocaine (also known as Lignocaine) prilocaine bupivacaine levobupivacaine ropivacaine mepivacaine dibucaine What is the most common general anesthesia available? Ketamine (Ketalar) Brand Names: Ketalar What is ketamine (Ketalar)? What are the possible side effects of ketamine (Ketalar)? What is the most important information I should know about ketamine (Ketalar)? How is ketamine given (Ketalar)? What happens if I overdose (Ketalar)? What other drugs will affect ketamine (Ketalar)? What is ketamine (Ketalar)? Ketamine is an anesthetic medication. Ketamine is used as a general anesthetic to prevent pain and discomfort during certain medical tests or procedures, or minor surgery. Ketamine may also be used for purposes other than those listed in this medication guide. What are the possible side effects of ketamine (Ketalar)? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have any of these serious side effects within 24 hours after you receive ketamine: •severe confusion; •hallucinations; •unusual thoughts; or •extreme fear. Less serious side effects may include: •dream-like feeling; •double vision; •jerky muscle movements; •dizziness, drowsiness; •nausea, vomiting, loss of appetite; or •sleep problems (insomnia). What is the most important information I should know about ketamine (Ketalar)? Before you receive ketamine, tell your doctor if you are allergic to any drugs, or if you have a history of alcoholism. It may take you longer to recover from anesthesia with ketamine if you have recently used a barbiturate such as phenobarbital (Luminal) or secobarbital (Seconal), or a narcotic medication such as fentanyl (Actiq, Duragesic), hydrocodone (Lortab, Vicodin), oxycodone (OxyContin), propoxyphene (Darvocet, Darvon), and others. Ketamine may be harmful to an unborn baby. Before you receive ketamine, tell your doctor if you are pregnant. You may feel strange or slightly confused when you first come out of anesthesia. Tell your caregivers if these feelings are severe or unpleasant. Ketamine can cause side effects that may impair your thinking or reactions for 24 hours or longer. Be careful if you drive or do anything that requires you to be awake and alert. You will probably not be allowed to drive yourself home after your surgery or medical procedure. Follow your doctor's instructions about any restrictions on food, beverages, or activity after you recover from anesthesia. How is ketamine given (Ketalar)? Ketamine is given as an injection through a needle placed into a vein or muscle. You will receive this injection in a clinic or hospital setting. Your caregivers will monitor your heart function, blood pressure, and breathing while you are under the effects of ketamine. You may feel strange or slightly confused when you first come out of anesthesia. Tell your caregivers if these feelings are severe or unpleasant. What happens if I overdose (Ketalar)? An overdose of ketamine is unlikely to occur since the medication is given by a doctor. Your vital signs will be closely watched while you are under anesthesia to make sure the medication is not causing any harmful effects. What other drugs will affect ketamine (Ketalar)? Before you receive ketamine, tell your doctor if you have recently used any of the following: •a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton); or •narcotic medication such as fentanyl (Actiq, Duragesic, Ionsys), hydrocodone (Lortab, Vicodin), hydromorphone (Dilaudid, Palladone), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin, Oramorph), oxycodone (OxyContin, Percocet, Roxicodone), propoxyphene (Darvocet, Darvon), and others. If you are using any of these drugs, it may take you longer to recover from anesthesia with ketamine. There may be other drugs that can affect ketamine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor. INDICATIONS Ketalar is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. Ketalar is best suited for short procedures but it can be used, with additional doses, for longer procedures. Ketalar is indicated for the induction of anesthesia prior to the administration of other general anesthetic agents. Ketalar is indicated to supplement low-potency agents, such as nitrous oxide. Preoperative Preparations 1.While vomiting has been reported following Ketalar administration, some airway protection may be afforded because of active laryngeal-pharyngeal reflexes. However, since aspiration may occur with Ketalar and since protective reflexes may also be diminished by supplementary anesthetics and muscle relaxants, the possibility of aspiration must be considered. Ketalar is recommended for use in the patient whose stomach is not empty when, in the judgment of the practitioner, the benefits of the drug outweigh the possible risks. 2.Atropine, scopolamine, or another drying agent should be given at an appropriate interval prior to induction. Onset and Duration The onset of action of Ketalar is rapid; an intravenous dose of 2 mg/kg (1 mg/lb) of body weight usually produces surgical anesthesia within 30 seconds after injection, with the anesthetic effect usually lasting five to ten minutes. If a longer effect is desired, additional increments can be administered intravenously or intramuscularly to maintain anesthesia without producing significant cumulative effects. Dosage Dosage & When it is to be taken : Adult: IV- 1-4.5 mg/kg as inj or infuse 1-2 mg/kg at 0.5 mg/kg/min. IM- 6.5-13 mg/kg. As with other general anesthetic agents, the individual response to Ketalar is somewhat varied depending on the dose, route of administration, and age of patient, so that dosage recommendation cannot be absolutely fixed. The drug should be titrated against the patient's requirements. Induction Intravenous Route: The initial dose of Ketalar administered intravenously may range from 1 mg/kg to 4.5 mg/kg (0.5 to 2 mg/lb). The average amount required to produce five to ten minutes of surgical anesthesia has been 2 mg/kg (1 mg/lb). Alternatively, in adult patients an induction dose of 1 mg to 2 mg/kg intravenous ketamine at a rate of 0.5 mg/kg/min may be used for induction of anesthesia. In addition, diazepam in 2 mg to 5 mg doses, administered in a separate syringe over 60 seconds, may be used. In most cases, 15 mg of intravenous diazepam or less will suffice. Rate of Administration It is recommended that Ketalar be administered slowly (over a period of 60 seconds). More rapid administration may result in respiratory depression and enhanced pressor response. Adult patients induced with Ketalar augmented with intravenous diazepam may be maintained on Ketalar given by slow microdrip infusion technique at a dose of 0.1 to 0.5 mg/minute, augmented with diazepam 2 to 5 mg administered intravenously as needed. In many cases 20 mg or less of intravenous diazepam total for combined induction and maintenance will suffice. However, slightly more diazepam may be required depending on the nature and duration of the operation, physical status of the patient, and other factors. Anesthesiologist Skills The job includes administering anesthetics to prevent the patients from feeling pain and sensations during the surgeries. It also involves monitoring the vital signs of the patient during surgery or medical procedure and carry out the necessary adjustments accordingly. It involves monitoring the patient through the initial recovery stage and administer drugs and medications that are essential during recovery The job description is not limited to the surgical room. They also help in pain management, to patients suffering from chronic pain such as respiratory and neurological illnesses. She also needs to discuss with physicians and medical professionals, regarding the type and method of anesthetics to be administered to the patient. This job also involves the examination of the patient before the surgery, getting his medical history and determining the risk involved during surgery or medical procedures. Recording the amount of anesthesia administered and the condition of the patient throughout the procedure is also a part of this job. She positions the patient on the operating table to provide maximum comfort and providing surgical accessibility to both the patient and the surgeon. It also involves providing and maintaining life support and airway management during an emergency. She also helps prepare a patient before an emergency surgery. She needs should know how to administer three types of anesthesia. This includes general, local as well as regional. The general anesthesia makes the patient loss conscious, local makes just a particular part of the body numb and regional makes the entire body go numb. Anesthesia for Thoracic Surgery Cardiovascular Anesthesia Critical Care Medicine ENT/ Difficult Airway Rotation Neuroanesthesia Post Anesthesia Care Unit Pain Service Pediatric Anesthesia Regional Anesthesia Obstetric Anesthesia |