Reader, Deptt of Shalya Tantra Section of Sangyaharan R.G.G.P.G Ay College, Paprola Thiopentone sodium • Type: Ultra-short acting thiobarbiturate • Dose and administration: 3-5mg/kg of 2.5% conc.i.v. prepared in Normal saline/distilled water SYSTEMIC EFFECTS • C.N.S : Produces effects in <30sec after i.v inj. There is progressive depression of CNS, including spinal cord reflexes. Central effects: sedation, anesthesia, resp depression, anti-convulsant,retrograde amnesia and depression of VMC. • CVS :Decreased Myocardial contractility Peripheral vasodilatation This leads to Hypotension Tachycardia Systemic effects contd… • Respiratory system • Respiratory depressant Centrally mediated resp depression & decreased sensitivity to Carbon dioxide Transient Apnoea
Laryngeal reflex intact
Coughing, laryngeal spasm and bronchoconstriction may occur, particularly in asthmatics • Eyes – IOP decreased by 40% light reflex lost corneal, conjunctival,eyelids,eyelash reflex lost. • Hepatorenal functions: Impaired transiently • Uterus and placenta: uterine tone unaffected Lipid solubility allows passage across placenta. Adverse effects • Hypotension • Respiratory depression • Tissue necrosis-(periveinous injection) • Laryngospasm- results from(a) direct local stimulation(airway,blood,saliva) (b)stimulation of remote area(anal sphincter,cervix uteri) • Allergic reactions – ranges from cutaneous rashes to severe anaphylaxis • Thrombophlebitis Intra-arterial inj • Follows arterial cannulation • Clinical features: complain of intense burning pain forearm and hand may be blanched and blisters may appear distally. • Cause: change in the pH of thoipentone when mixing with blood > ppt of solid crystal>cause NAd realese> vasocostriction, thrombosis formed by endarteritis,aggregation of platelets emboli ischemia or gangrene. Management Leave cannula in place • Vasodilator (e.g papaverine 40-80mg in 10-20ml of N.S i.v., phenoxybenzamine 0.5mg i.v) • Stellate ganglion and brachial plexus block • i.v heparin 500 units, reverses alkalinity and prevents thrombosis. • Oral anticoagulants Absolute contraindications • Airway obstruction- in epiglottitis,oral or pharyngeal tumors. • Porphyria- LMN paralysis & severe CVS collapse. Induction of gamma aminolivulinic acid> production of porphyrin. • Previous hypersensitivity reaction • Bronchial asthma Ketamine • Phenylcyclidine derivative. • Dose: 1-2mg/kg i.v for induction 4-6 mg/kg i.m. 25-100µg/kg/min i.v infusion. Systemic effects • CNS: increases cerebral blood flow, metabolism,and ICP. • Respiratory system: resp depression less than other anesthetic agents. Pharyngeal reflexes are preserved. • Powerful bronchodilator due to direct sympathomimetic effect. • Increased salivation leads to chances of upper airway obstruction. • CVS: heart rate. B.P., C.O., myocardial Oxygen consumption increased. Sensitizes heart to small doses of epinephrinecan precipitate arrythmia. • Pain: Central sensitization is reduced after tissue injury. Prevents growth of new pain pathways . Phonation,nystagmus,eye movements and limb movements are common. Adverse effects • Emergence Phenomenon Can occur upto 24hrs & includes hallucinations. May be reduced by premedication with benzodiazepines. • may produce psychosis Contra-indication • Raised ICP • I.H.D., Vascular aneurysm: Ketamine causes hypertension and tachycardia. • Psychiatric disease • Subrachnoid use: preservative chlorobutanol is neurotoxic. Precautions • Stomach and bladder should be empty. • Following should be in hand • Laryngoscope • Tracheal tubes • Oxygen • Mask and reservior bag • Tilting table • Suction apparatus • Suitable syringes and needles • Normal resuscitation equipments. Recovery from anesthesia • Nurse the patient in lateral position. • Oxygen should be administered. • Watch airway and tidal exchange carefully. • Day cases should always be accompanied • Pts should be asked not to drive or engage in responsible activity for 24 hrs. The return of normal mental faculties does not accompany apparent return of full consciousness. Thanks