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14.02.13 Anaesthetic drugs

Induction agents

 GoodBad
Dose
KetamineLess hypotension than thiopental and propofol
Good for kids
Good for repeated dosing
Recovery is relatively slow
High incidence of extraneous muscle movements
Hallucinations, nightmares, etc
6.5–13 mg/kg IM
1–4.5 mg/kg IV
Maintenance: 10–45 micrograms/kg/minute IVI
PropofolRapid recovery
Less hangover effect
Pain on IV injection
Extraneous muscle movements
Bradycardia
Convulsions
1.5–2.5 mg/kg at a rate of 20–40 mg every 10 seconds
Maintenance: 4–12 mg/kg/hour
ThiopentoneSmooth and rapid induction

Dose-related cardiovascular and respiratory depression
Slow metabolism
No analgesic properties
Initially 100–150 mg; Repeat if necessary
EtomidateRapid recovery without a hangover effect
Less hypotension than thiopental and propofol

High incidence of extraneous muscle movements
Pain on injection
Suppresses adrenocortical function
150–300 micrograms/kg

Muscle relaxants

 Onset (secs)
Duration (mins)
Notes
Dose
Atracurium120
25 - 30
Degraded by Hofmann elimination
Insignificant placental transfer
Cardiovascular effects
0.3-0.6 mg/kg
Rocuronium60
30 - 40
Minimal cardio/resp effects0.6 mg/kg
Vercuronium150
15 - 30
 0.1 mg/kg
Suxamethonium30 - 60
5 - 10
NB Pseudocholinesterase deficiency
=> Bradycardia, Hyperkalaemia
Risk of malignant hyperthermia
1 - 2 mg/kg

Analgesics

 Dose
Morphine10 mg
Diamorphine5 mg
Fentanil50–100 micrograms
AlfentanilUp to 500 micrograms
Remifentanil0.25–1 micrograms/kg
Midazolam2–2.5 mg

Local anaesthetics

 Strength
Max. doseNotes
Lidocaine
(Lignocaine)
1 %
3 mg/kg
7 mg/kg with adrenaline
Local
Levobupivacaine0.75 %
150 mg
Local / Epidural / Intrathecal / Blocks
Fewer adverse effects than bupivacaine

Antiemetics

 NotesDose
Cyclizine 50 mg PO/IV
Metoclopramide 10 mg PO/IV
Prochlorperazine 12.5 mg IM
OndansetronImmediate onset - Give before waking
8 mg PO/IV
DexamethasoneDelayed onset - Give at induction
0.4 - 20 mg IV

Antimuscarinics

 NotesDose
AtropineVagotonic
Not generally used as pre-med
300–600 micrograms
Glycopyrronium bromide
Reduces salivary secretions
Produces less tachycardia than atropine
200–400 micrograms
Hyoscine hydrobromide
Reduces secretions
Amnesia, sedation, anti-emesis
May produce bradycardia rather than tachycardia
Possibility of central anticholinergic syndrome
200–600 micrograms

Cardiac

 MOA
   
Noradrenaline    
MetaraminolAlpha-selective adrenergic agonist
   
GTN
   
Labetalol    
Dopexamine    
EphedrineMixed alpha/beta adrenergic agonist
   
Adrenaline
   
Phenylephrine    
MilrinonePDE3 inhibitor
Increases contractility
Also vasodilation => Reduced afterload
   

Antibiotics

     
 Amoxicillin    
 Clindamycin    
 Flucloxacillin    
 Erythromycin    
 Gentamicin    
 Benzyl-penicillin    
 Cefurozime    
 Vancomycin    

General

      
 Frusemide     
 Doxapram     
 Hydrocortisone     
 Heparin     
 Ranitidine     
 Dexamethasone     
 Naloxone     
 Tranexamic acid     
 Diclofenac     

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