ANESTHESIA ROTATION (Source: MIMS.

com )

DRUGS BRAND CLASS MOA INDICATIONS Advantage SIDE EFFECTS SPECIAL PRECAUTIONS Doses
LOCAL ANESTHETHICS
BUPIVACAINE Ascain Local Blocks both the Acute pain CARDIOTOXIC Contraindicated:Patients
HEAVY AND Anesthetic initiation and Postoperative pain Impairs locomotion with active CNS dse, TB of
BUPIVACAINE 0.5% conduction of nerve Surgical anesthesia and alertness the spne, pyogenic
(Isobaric) impulses reducing Peripheral nerve block, Bradycardia, infection at injection site,
(sic: what is the permeability of Sympathetic nerve block, hypotension, pre-anes elevated
isobaric?: same neuronal epidural and caudal blocks hypertension, intracranial pressure
specific gravity ) membranes to Na nauseam, Obstetrical paracervical
ionsinhibition of vomiting, diplopia, blocks and IV regional
depolarizationresu neuropathy, anesthesia
ltant blockade peripheral nerve
conduction injury,
Onset: 1-17 mins arachnoiditis,
Duration 2-9 hrs paresis, paraplegia,
(cross placenta, CNS toxicity
diffuses into CSF and (paresthesia,
enters breast convulsions,
milk(small amts) tremor), dizziness,
allergic rxns
Potentially fatal:
cardiac
arrhythmia,
cardiac and
respiratory arrest
LIDOCAINE 2% Xylocaine Local Lidocaine is an Epidural anesthesia Patients with Patient w/
(Lidocaine Anesthetic amide type local Spinal anesthesia hepatic pseudocholinesterase 2-3 mL
HCl) anaesth. IV regional anesthesia impairment: deficiency, resp administered
It stabilises the Surface anesthesia dosage reduction depression. for each
neuronal Peripheral nerve block Incompatible with Hepatic and renal dermatome
membrane and Amphotericin B, impairment. to be
inhibits Na ion sulfadiazine Na, Elderly or debilitated anaesthesised
movements, methohexital Na, patients. .
 which are cefazolin Na, Pregnancy and lactation.
necessary for phenytoin Na,
conduction of pantoprazole,
impulses. In the metoprolol.
heart, lidocaine Arrhythmia,
reduces bradycardia,
depolarisation of arterial spasms, CV
the ventricles collapse, oedema,
during diastole flushing, hert
and automaticity block,
in the His- hypotension, sinus
Purkinje system. node suppression,
Duration of agitation, anxiety,
action potential coma, confusion,
and effective drowsiness,
refractory period hallucinations,
are also reduced. euphoria,
Onset: 45-90 sec headache,
(IV); approx 4 hr hyperaesthesia,
(transdermal); 20 hypoaesthesia,
sec to 5 min lightheadedness,
(ophth). . lethargy,
Duration: 10-20 min nervousness,
(IV); 5-30 min psychosis, seizure,
(ophth). slurred speech,
unconsciousness,
somnolence,
nausea, vomiting,
metallic taste,
tinnitus,
disorientation,
dizziness,
paraesthesia, resp
depression and
convulsions. Patch:
Bruising,
 depigmentation,
petechiae,
irritation. Ophth:
Conjunctival
hyperaemia,
corneal epithelial
changes,
diplopia,visual
changes.
GENERAL ANESTHETHICS
PROPOFOL Fresofol General short-acting IV INDUCTION AND Induction: Reduce dose: Caution
Spiva anesthetic general anesthetic MAINTENANCE OF GENERAL Hypotension should be exercised in
ANESTHESIA; (require IV fluids, patients with cardiac,
sedation of ventilated patients vasoconstrictive respiratory, kidney or liver
in the intensive care unit (ICU); drugs, slower disease
sedation for diagnostic and administration)
surgical procedures, alone or in Transient apnea
combination with local or Myclonism and
regional anesthesia. movements
Maintenance:
Coughing
Recovery:
Nausea, vomiting,
headache,
shivering,
sensations of cold,
euphoria, sexual
disinhibition
Accidental
overdose is likely
to CAUSE CARDIO-
RESPIRATORY
DEPRESSION.
Treat respiratory
depression by
artificial
 ventilation.
Cardiovascular
depression may
require lowering
the patient's head
and administering
plasma expanders
and pressor
agents.
Contraindications:
Patients with
known
hypersensitivity to
propofol or to any
of the constituents
of Spiva with MCT-
LCT. In children <1
month for
induction and
maintenance of
anesthesia. In
patients 16 years
for sedation in
intensive care.
Pregnant
SEVOFLURANE Sevoflurane General A volatile Induction & maintenance of May cause SEVOFLURANE Sevoflurane/c
/cc (abbott) Anesthetic halogenated general anesth in adult and ped MALIGNANT c (abbott)
SEVO /cc general patients for inpatient and HYPERTHERMIA SEVO /cc
(endure) anaesthetic that outpatient surgery. Cardioresp (endure)
has a minimum depression,
alveolar hypotension
concentration Agitation
(MAC) value (especially in
ranging from childn),
1.4% to 3.3%. laryngospasm,
It alters the increased cough &
 activity of fast salivation.
synaptic Acute renal
neurotransmitter failure.
receptors like Shivering, nausea
nicotinic & vomiting
acetylcholine, Interactions:
GABA, and Adrenaline or other
glutamate. sympathomimetics
It may depress
myocardial
contractility and
decrease both BP
and sympathetic
nervous activity.
Additionally, it
has muscle
relaxant
properties w/o
analgesia.
Onset: W/in 2-3 min.
NEUROMUSCULAR BLOCKING AGENTS
ATRACURIUM Atracor Neuromuscular Adjunct to general anesth to Tachycardia Assist or control respiration
Blocking agents enable tracheal intubation, Increased BP until atracurium is Adult &
(Non relax muscles during surgery or Reduced GI inactivated or antagonized childn
depolarizing) controlled ventilation. motility and tone Respiratory insufficiency o Initially
Ano lang yung Quaternary ammonium wheal & flare at pulmonary disease, 300-600
depolarizing? containing agents used as injection site neuromuscular disorders mcg/kg
Succinylcholine peripherally-acting muscle flushing Dehydrated or severely ill, body wt
! relaxants Occasionally Hx of asthma and by IV inj.
bronchospasm hypersensitivity to any Subseque
Rarely neuromuscular blockers ntly 80-
anaphylactoid 200
reactions mcg/kg
malignant after 15-
hyperthermia 25 min.
Patients
 w/ CV
disease
Initial
dose to
be
administe
red over a
period of
60 sec.
Prolonged
procedure
s:
continuou
s infusion
at a rate
of 5-10
mcg/kg/m
in
Atracor inj
10mg/mL (2.5
mL x 10 x 1s)
ROCURONIUM Non Rocuronium is a Adjunct to general anesthesia injection site Since rocuronium causes 100 mg/ml
depolarizing FAST ONSET to facilitate endotracheal pain/reaction, paralysis of the respiratory
neuromuscular (relative to intubation during routine changes in vital muscles, VENTILATORY
blocking agents vecuronium), induction, to provide muscle signs SUPPORT is mandatory for
INTERMEDIATE relaxation and to facilitate prolonged patients treated with
ACTING mechanical ventilation in neuromuscular recuronium bromide
nondepolarizing adults, children and infants >1 block injection. Ventilation
neuromuscular month. Overdosage: should be continued until
blocking agent. Adjunct to general anesthesia prolonged adequate spontaneous
It acts by to facilitate endotracheal paralysis, apnea, respiration is restored. As
competing with intubation during rapid low tidal volume, with all neuromuscular
the natural sequence induction(usually respiratory blocking agents, it is
transmitter done in trauma patients) when depression and/or important to anticipate
acetylcholine and suxamethonium is persistent muscle intubation difficulties,
blocking the contraindicated, however, this weakness (Mgt: particularly when used as
 cholinoceptors has not been studied in infants ventilator support part of a rapid sequence
located at the and in children. and sedation, induction technique.
motor endplate Adjunct in the intensive care Sugammadex(inten
of the striated unit to facilitate mechanical se deep block),
muscle.( This is ventilation. Acetylcholineester
unlike ase inhibitor
suxamethonium (neostigmine,
which causes edrophonium,
depolarization and
renders the
pyridostigmine, ith
endplate, after appropriate
initial contraction, vagolytic
unresponsive to (atropine))
stimuli, thus
producing paralysis
of the striated
muscle.)
Rocuronium does
not produce
clinically
significant
autonomic and
cardiovascular
effects within the
recommended
dose range and is
not expected to
modulate
cardiovascular
effects of
anesthetics or
other drugs used
during surgery.
The action of
rocuronium is
antagonized by
acetylcholinesterase
inhibitors eg,
neostigmine,
edrophonium and
pyridostigmine. The
neuromuscular block
can also be reversed
by sugammadex, a
selective relaxant
binding agent.
ANTIDOTES
ATROPINE SULFATE Antidotes & Reduces effects of Treatment of bradycardia & dry mouth, Tachycardic
Dteoxifying anticholineesterases asystole of various causes: CPR difficulty sallowing patients(thyrotoxicosis,
agents/ Tertiary amines procedures, muscarine tox, and talking, thirst, heart failure, cardiac
ANtispasmodic organophosph pesticide reduced bronchial surgery)
s poisoning secretions, dilation Downs syndrome,
Antimuscarinic Premedicant and counteracts of pupils or albinism, acute MI, HTN
agents anticholinesterases mydriasis with loss
(Sic: M1: (Neostigmine and other of accomodtaion
secretion from parasymphatomimetics,antispa or cycloplegia and
salivary glands smodic, photophobia,
and stomach, Decrease saliva and mucus flushing, dry skin,
CNS activates secretion transient
slow after adjunct to opioid analgesics bradycardia
depolarizing symp relief of biliary or renal followed by
potentials in colic tachycardia w/
neurons,EPSP treat or prevent bronchospasm palpitations and
autonomic arrhythmias,
ganglia(inc in + difficulty in
charges) M2: micturition,
slow heart rate, reduced GIT tone
reduce & motility,
contractile conjunctivitis, skin
force of atrium, rash, hyperthermia
reduce AV
node
conduction,)

SEDATIVES
MIDAZOLAM Dormicum/ Sedatives Midazolam binds Short term management of Severe respiratory Patients with HEPATIC
Sedoz to stereospecific insomnia failure or acute IMPAIRMENT(oral): dosage
benzodiazepine SEDATION for dental and minor respiratory reduction needed
receptors on the surgical procedures, critical depression, acute Pregnant
postsynaptic care narrow-angle Concomitant use with
GABA neuron at Premedication in surgery glaucoma, CYP3A4 inhibitors ex
several sites w/in myasthenia clarithromycin ,
the CNS, grvais,sleep apnea ketoconazole (increases
including the syndrome plasma concentration of
limbic system, Sedation, Midazolam)
reticular somnolence, Decreased concentrations
formation. confusion, with CYP3A4 inducers
Enhancement of impaired (rifampicin)Ethel booba
the inhibitory coordination,
effect of GABA diminished
on neuronal reflexes, coma, and
excitability alterations in vital
results by signs.
increased Management:
neuronal General supportive
membrane treatment.
permeability to Maintain patent
Cl ions, which airway and support
results in ventilation,
hyperpolarisation including admin of
(a less excitable oxygen. May
state) and admin IV fluids or
stabilisation. vasopressors if
Benzodiazepine hypotension
receptors and occurs. GI
effects appear to decontamination
be linked to the w/ lavage and/or
GABA-A activated charcoal
receptors. is recommended.
Onset: Sedation: 10- May give
20 min (oral); approx flumazenil as
 15 min (IM); w/in antidote.
approx 3-5 min (IV).
EPHEDRINE SULFATE Sedation of initially intubated Hypotension EPHEDRINE SULFATE
and mechanically ventilated Bradycardia
patients during treatment in an
intensive care setting. IT should
be administered by continuous
infusion not to exceed 24 hrs.
OPIOIDS
FENTANYL HCl Sublimaze Opioids Interacts with Breakthrough cancer pain, RESPIRATORY Head injury; increased
(Fentanyl receptors that (buccal, nasal, sublingual) DEPRESSION: intracranial pressure; renal
citrate) contributes to Adjunct to general Concomitant use or hepatic impairment;
supraspinal and anesthesia(IV) w/ CYP3A4 myasthenia gravis, cardiac
spinal analgesia Premedication before inhibitors (e.g. bradyarrhythmias, pre-
It raises the anesthesia (IM) erythromycin, existing pulmonary disease
threshold to pain Intractable chronic clarithromycin, (e.g. COPD) or condition
by interrupting pain(transdermal) troleandomycin, (e.g. hypoxia). Cachetic or
pain transmission azole antifungals, debilitated patients. Rapid
through ritonavir, IV infusion may cause
ascending amiodarone, skeletal muscle and chest
pathways and nefazodone, wall rigidity. Prolonged use
activating aprepitant, may cause tolerance,
descending diltiazem and psychological and physical
inhibitory verapamil) dependence. Abrupt
pathways increases serum withdrawal may lead to
Fentanyl is a levels of fentanyl withdrawal symptoms,
potent OPIOID and may gradually taper down the
ANALGESIC that potentiate fatal dose to avoid this risk.
increases pain resp depression. Elderly. Pregnancy and
threshold, Increased risk of lactation.
alters pain life-threatening
reception SEROTONIN
inhibits SYNDROME w/
ascending pain SSRIs, SNRIs and
pathways by MAOIs. May
binding to reduce serum
 stereospecific levels w/ rifamycin
receptors w/in derivatives.
the CNS Enhanced
Onset: IV: Rapid; depressant effect
IM: Approx 7-15 w/ general
min; Transdermal anaesth,
(initial tranquilisers,
placement): 6 hr; barbiturates and
Transmucosal: 5- narcotics.
15 min. May increase
Duration: IV: 30- excretion w/
60 min ammonium Cl.
May increase
hypotensive effect
w/ phenothiazines.
May reduce
efficacy of
pegvisomant.
Debiliatated
patients: dose
reduction
CONTRAINDICTAIO
NS: Opioid
nontolerant
patient. Treatment
of acute pain other
than breakthrough
pain (e.g. migraine
or other
headaches) or
post-op pain; acute
or severe resp
depression or
obstructive lung
disease; paralytic
ileus.
 Incompatible with
THIOPENTAL Na
and
METHOHEXITAL Na
NALBUPHINE HCL Nubain Opioid Nalbuphine is a Adjunct in balanced Sedation, dizziness, Reduce dose in renal and
phenanthrene anesthesia(Intravenous) vertigo, miosis, hepatic impairment
derivative w/ Moderate to severe pain headache; Emotionally unstable
MIXED OPIOID (Parenteral) depression, patients.(bawal sa clerks
AGONIST AND restlessness, na toxic na char!:P)
ANTAGONIST nervousness, Patient w/ MI who exhibit
activity (agonist crying, nausea and vomiting,
at kappa opiate drunkenness, history of opiate abuse,
receptor; partial euphoria, floating, impaired respiration due to
antagonist at hostility, confusion, other drugs, uraemia,
receptor). It unusual dreams, bronchial asthma, severe
inhibits the faintness, feeling infection, cyanosis or resp
ascending pain of heaviness, obstruction; about to
pathways, alters tingling, undergo biliary tract
the perception of numbness; nausea, surgery; head injury,
and response to vomiting, dry intracranial lesions or pre-
pain by binding mouth; existing increased
to opiate bradycardia, intracranial pressure. Renal
receptors in the tachycardia, HTN, or hepatic impairment.
CNS. hypotension, Pregnancy and lactation.
It also produces pulmonary
generalised CNS oedema; itching,
depression. burning, urticaria;
Onset: 2-3 min resp depression,
(IV); <15 min dyspnoea, asthma;
(IM/SC). speech difficulty,
Duration: 3-6 hr. urinary urgency,
blurred vision,
flushing, warmth,
sweatiness,
clamminess.
Potentially Fatal:
 ANAPHYLACTIC OR
ANAPHYLACTOID
and other serious
hypersensitivity
reactions (e.g.
shock, resp distress
or arrest,
bradycardia,
cardiac arrest,
hypotension,
laryngeal oedema).
Incompatible: Y-
site: Allopurinol,
amphotericin B
cholesteryl sulfate
complex, cefepime,
docetaxel,
methotrexate,
nafcillin,
piperacillin/tazoba
ctam, pemetrexed,
sargramostim, Na
bicarbonate.
Syringe: Diazepam,
dimenhydrinate,
ketorolac,
pentobarbital
MORPHINE SULFATE Opiods Morphine is an Relief of moderate to severe Acute overdosage Must not be used by 16mg
OPIOID AGONIST pain with morphine can pregnant and
WITH NO be manifested by breastfeeding patients
ANTAGONISTIC RESPIRATORY History of substance abuse,
ACTION. DEPRESSION, severely impaired hepatic
Central Nervous somnolence function, raised intracranial
System: The progressing to pressure, severe chronic
principal actions stupor or coma, obstructive lung disease,
of therapeutic miotic pupils, hypotension with
value of rhabdomyolysis hypovolemia, severe cor
morphine are progressing to pulmonale, biliary tract
analgesia and renal failure, disorders, severe bronchial
sedation (i.e., skeletal muscle asthma, pancreatitis,
sleepiness and flaccidity, respiratory depression,
anxiolysis). bradycardia, severe renal dysfunction.
Morphine hypotension and
produces death.
respiratory A patent airway
depression by must be
direct action on maintained. The
brainstem pure opioid
respiratory antagonists are
centers. specific antidotes
against the effects
of opioid overdose.
Other supportive
measures should
be employed as
needed.
Crushing and
taking the contents
of a modified
release dosage
form leads to the
release of the
morphine in an
immediate fashion;
this might result in
a fatal dose.
Morphine should
be used with
caution in patients
who are
concurrently
receiving other
 central nervous
system
depressants
including sedatives
or hypnotics,
general
anesthetics,
phenothiazines,
other tranquilizers,
gabapentin and
alcohol. Interactive
effects resulting in
respiratory
depression,
hypotension,
profound sedation,
or coma may result
if these drugs are
taken in
combination with
the usual doses of
morphine.
Morphine should
not be co-
administered with
monoamine
oxidase inhibitors
or within two
weeks of such
therapy.
OTHERS
EPINEPHRINE Adrenin, Cardiac Drugs, Epinephrine, an IV: advanced cardiac life support, Overdosage CNS effects; GI disturbances;
Epix, Sympathomime active principle anaphylactic shock, RETARD intravascular inj of epigastric pain; CV disorders;
Ephedrix, tics of the adrenal DIFFUSION AND LIMIT epinephrine may difficulty in micturition with
Epix, medulla, is a ABSORPTIONMADAMI PA NA cause cerebral urinary retention; dyspnoea;
Adrenaline, direct-acting LOCAL ANSPROLONG THE haemorrhage due hyperglycaemia; sweating;
 Epinephrine sympathomimeti DURATION OF EFFECTLESS TOXIC to a sharp rise in hypersalivation; weakness,
c. It stimulates - BP. tremors; coldness of
and -adrenergic Fatalities may also extremities; hypokalaemia.
receptors result from Gangrene, tissue necrosis and
resulting in pulmonary edema sloughing (extravasation) when
relaxation of because of used in addition to local
smooth muscle peripheral vascular anaesthetics. Eye drops:
of the bronchial constriction Severe smarting, blurred
tree, cardiac together with vision, photophobia; naso-
stimulation and cardiac lachrymal ducts obstruction.
dilation of stimulation. Oedema, hyperaemia and
skeletal muscle CONTRAINDICTAIONS: inflammation of the eyes with
vasculature. When used in addition repeated administration
It is frequently to local anaesthetics:
added to local Procedures involving
anaesthetics to digits, ears, nose,
retard diffusion penis or scrotum.
and limit
absorption, to
prolong the
duration of effect
and to lessen the
danger of toxicity
Onset: SC:
approx 5-10 min;
inhalation:
approx 1 min;
conjunctival
instillation: IOP
declines approx 1
hr.
Duration: Ocular
effect: 12-24 hrs.
PARECOXIB Dynastat NSAIDs COX 2 selective For the SHORT TERM If administered Reduce dose in renal 40mg
(Parecoxi inhibitor TREATMENT of acute pain and with impairment (lowest dose)
Sodium) post-operative pain i.e., oral fluconazole(lowest
 surgery, abdominal dose)
hysterectomy, myomectomy, Contraindications:
total knee replacement, total hypersensitivity to
hip arthroplasty, laparoscopic the drug, allergic
cholecystectomy, inguinal to sulfonamides
hernia repair and other general By reducing
surgery like diagnostic inflammation,
laparoscopy, gastrectomy, parecoxib
hernioplasty, appendectomy, (Dynastat) may
hemithyroidectomy and diminish the utility
splenectomy. of diagnostic signs
It may be used pre-operatively such as fever, in
to PREVENT OR REDUCE POST- detecting
OPERATIVE PAIN; and it can infections. The
reduce opioid requirements concomitant use of
when they are used parecoxib
concomitantly. (Dynastat) with
At recommended doses, other non-specific
significantly REDUCED OPIOID NSAIDs should be
CONSUMPTION AND PATIENT- avoided.
REPORTED OPIOID-RELATED
ADVERSE EFFECTS (fatigue,
drowsiness, confusion, inability
to concentrate, dizziness,
nausea, constipation, difficult
urination, itching,
retching/vomiting), while
providing improved pain relief
compared to opioids alone.
It is only indicated for patients with
a need for parenteral therapy and
for whom a similar benefit could
not be obtained from alternative
oral therapy. It is recommended
that patients be transitioned to
alternative oral therapy as soon as
 clinically indicated.
DICLOFENAC Diclowal/
Voltaren
(Diclofenac
Na)
FUROSEMIDE Furoscan
FUSIDATE SOIUM 15 Fucidin 15g
g
HYOSCINE (XSPAS)
ISOTONIC 50mL NSS
KETAMINE(off Ketazol
market)
KETOROLAC Kortezor

MEGLUMINE Telebrix 30ml
METHYLERGOMENT Cethergo
RINE

NEOSTIGMINE Prostigmine
OXYTOCIN Evatocin
PARACETAMOL Aeknil

PIROXICAM Macroxam
Patch
PROMETHAZINE HCl Systemic
(off market) antihistamines
STERILE H2O 50 ml
TRAMADOL HCL TDL
VECORONIUM Norcuron 4mg
ANES GASES
DESFLURANE
ISOFLURANE
Estimation of blood loss (aspiration - fluids infused) + OS (2x2 gauze pads soaks 4 mL of blood and 4x4 gauze pads soaks 10mL of blood)
<3 Anes Clerks June-July 2017 ft. THE Dr. Salvador <3