1. Biomedical Engineering Lecture on Drugs for sedation, general anesthesia, and other purposes

2. Ready

3. Drugs for sedation, general anesthesia, and other purposes James H. Philip MD CCE Thanks to Dan Raemer who contributed significantly to the drug list and explanations..

4. Another Hat for Anesthesiologists Chronic Pain Management Medications Opioids, anti-inflammatory Regional injections Opioids, local anesthetics, steroids, neurolytics Electrical stimulation Surgery Psychiatric counseling TLC

5. Regional Anesthesia

6. Regional Anesthesia - Nerve Blocks Minor Local, field block Major Spinal Epidural Major Plexus

7. Spinal Cord and Epidural Space CSF Epidural space Dura Ligament Spinal nerves Spinal cord Subdural space

8. Spinal Cord and Epidural Space CSF Ligament Spinal nerves Spinal cord Epidural space Dura Subdural space (widened)

9. Spinal Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

10. Spinal Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

11. Spinal Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

12. Spinal Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

13. Epidural Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

14. Epidural Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

15. Epidural Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

16. Epidural Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

17. Epidural Anesthetic CSF Ligament Spinal cord Epidural space Dura Subdural space

18. Conscious Sedation

19. Monitored Anesthesia Care - MAC No relation to Minimal Anesthesia Concentration MAC Conscious Sedation IV drugs Sedative-hypnotic Analgesic Inhaled drugs Low concentrations for consciousness

20. Unconscious Sedation Is dangerous May be more dangerous than general anesthesia Airway may not be secure Breathing may stop Circulation is maintained until breathing stops Difficult to monitor

21. That is why Many anesthesiologists prefer General Anesthesia over Sedation Once A= airway is secure, B= Breathing and C = Circulation are the only worries!

22. Anesthesia Drugs

23. Sedatives / hyponotics Analgesics (Opiods) Other adjuvants Induction Agents Muscle Relaxants Antagonists Local Anesthetics System-specific (CV, Resp, Neuro, Renal)

24. Benzodiazepines Midazolam Diazepam Lorazepam VERSED VALIUM ATIVAN Amnesia Hypnosis/Sedation Anxiolysis

25. Opioids (analgesics, narcotics) Morphine Fentanyl Sufentanil Alfentanil Remifentanil ********* SUBLIMAZE SUFENTA ALFENTA ULTIVA Analgesia Respiratory Depression Sedation

26. Other protectors Anti-nausients; anti-emetics Reflex blockers Muscle-fasciculation blockers

27. Nausea and Vomiting Nausea and vomiting are still common 10 - 20% men 20 - 70% women Likely related to Opiods Surgery Nitrous Oxide Other agents Pain

28. Anti-nausients/Anti-emetics Reglan (Metaclopramide) empties stomach (down - the right way) Anti-dopaminergic - Droperidol Anti-seritonin - Zofran Anti-motion - anti-histamines, other Other

29. Reflex Blockers Atropine/Scopolamine- blocks Vagus nerve prevents bradycardia prevents salivation Esmolol - Beta blocker prevents tachycardia Labetalol - Blocks hypertension

30. Induction Agents - IV Sodium Thiopental Propofol Etomidate Ketamine PEN TOTHAL DIPRIVAN AMIDATE KETALAR Unconsciousness Hypnosis/Sedation +

31. Induction Agents - IV Sodium Thiopental Propofol Etomidate Ketamine PEN TOTHAL DIPRIVAN AMIDATE KETALAR Unconsciousness Hypnosis/Sedation + - Central Apnea Airway obstruction Hypotension Bradycardia Decreased CO

32. Induction Agents - Inhalation Sevoflurane Halothane (kids) ULTANE FLUOTHANE Unconsciousness Hypnosis/Sedation + - Central Apnea Airway obstruction Need for A,B Changed CO

33. Maintenance - Inhalation Agents Halothane Isoflurane Desflurane Sevoflurane Nitrous Oxide FLUOTHANE FORANE SUPRANE ULTANE/SEVORANE “Gas” Unconsciousness Analgesia Muscle relaxation Amnesia + - Tachypnea Hypotension Brady/Tachycardia Decreased CO

34. Muscle Relaxants Succinylcholine dTC Pancuronium Vecuronium Atricurium Doxacurium Pipecuronium Rocuronium Mivacurium Cis-Atricurium Neuromuscular blockade = Muscle relaxation = paralysis

35. Muscle Relaxants Succinylcholine dTC Pancuronium Vecuronium Atricurium Doxacurium Pipecuronium Rocuronium Mivacurium Cis-Atricurium Neuromuscular blockade = Muscle relaxation = paralysis Temporary and reversible

36. Local Anesthetics Lidocaine Bupivicaine Ropivacaine Mepivacaine Procaine 3-Chloroprocaine Tetracaine Cocaine Block nerve conduction Prevent sensation (sensory block) Prevent motion (motor block)

37. Reversal of NMB Neostigmine allows acetyl choline build-up acetyl choline knocks NMBs off receptors Glycopyrolate or atropine blocks side effects of Neostigmine Bradycardia, Bowel constriction

38. Cardiovascular Drugs Pressors (increase Blood Pressure) Phenylephrine, Epinephrine, Norepinephrine Ephedrine, Dopamine, Dobutamine Accelerators (speed Heart) Atropine, Isoproterinol (Isuprel) Anti-Hypertensives (lower Blood Pressure) Nitroprusside, Hydralazine, Labetalol, NTG Antiarrhythmics Lidocaine, Beryllium

39. The End Actually, the beginning

40. End