Download - Ketamine (ketalar)2
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عمومی جراحی دیپارتمنت
کنفرانس :KETAMINE موضوعمحمد : ترینرمتخصصداکترسلطان رهنما استاد
نیازی” ”
کننده : ترینی ٭روفي٭ دسمیع محمداکترترتیبشفاخانه عمومی جراحی اول سال
.جمهوریت ۹۱ - ۷ – ۸تاریخ:
GENERAL ANESTHESIA
Ketamine
Components of General AnesthesiaMuscle RelaxationUnconsciousnes
sAnalgesia
Muscle Relaxation
Amount of skeletal muscle relaxation requirements depend on the type of operation.
Components of General Anesthesia
Analgesia/ Areflexia
Pain reflexes are subdued.
Components of General Anesthesia
Unconsciousness/Hypnosis
The patient is oblivious to all sensation but pain reflexes can
occur .
Components of General Anesthesia
Vital signs Stage of general anesthesia Airway, respiratory and cardiac
systems Input and output of all fluids and
drugs Time Recording Communications
The circle helps the anesthetist to monitor and manage:
Ketamine
Ketamine – I /V anesthetic Produces dissociative anesthesia: 1. Patient is unconscious 2. amnesic 3. deeply analgesic as sole anesthetic agent Can also be used with muscle
relaxants
Introduction
√WHY WE USE KETAMINE ? √WHEN WE USE KETAMINE?√WHERE WE USE KETAMINE?√HOW TO BE USED KETAMINE?
OBJECTIVES
• WHY WE USE KETAMINE ?
It is G/A agent.To achieve the purpose.To operate patient very safely .
•WHERE WE USE KETAMINE ?
When every needed instrument for reanimation and recovery of the patient is available (operating room).
•HOW TO BE USED KETAMINE ?
Produces dissociative anesthesia: unconscious amnesic deeply analgesicsoluble in waterSoluble in fat tissueQuickly observedBring anesthesia very quickly.
کیتامین خواص
Total I/V anesthetic safe drug but need
caution sole anesthetic agent – Can also be used with muscle
relaxants
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Pharmacokinetics of Ketamine Metabolism
Metabolized by the hepatic microsomal system (CYP3A4, CYP2C9 and CYP2B6).
N- demethylation
ketamine norketamine
(metabolite I)
20
Norketamine (NK) has 20-30% of the ketamine activity
NK hydroxlyated to Hydoxynorketamine, conjugated with glucuronate and excreted in the urine.
عضویت های سیستم باالی کیتامین تاثیرات
Brain vessels dilatation increased intracranial pressure hallucinations increased C . B . F
C.N.S
1 .Sympathomimetic cardiovascular effects
2. Increase artery & venous BP. BP increase 20-40 mmHg .
for 10-20 min .
3 . heart rate will go up. Useful for patients in shock
4 . Good flow of coronary artery .
C.V.S
Apnea – relatively rare occurrence with ketamine – can minimize risk by giving slow IV injection
Cholinergic salivary and bronchial gland secretion
Cough reflex and swallowing reflex remain positive.
Pharyngeal and laryngeal reflexes are usually intact: Patient can breathe on her own
Good ventilatory response: Increased respiration rate and tidal volume—oxygenation is maintained
R . S
1. Increase intra ocular pressure
2. Pupil reflex failure .
Eye
For induction1-2mg/kg/IV4-8mg/kg/IMTo continue anesthesia
1mg/kg Infusion 0.2mg/kg/min/infusion
Doseage
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Doses, Routes of Administration
Side effectes of ketamineserious 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).
•WHEN WE USE KETAMINE ?
کیتامین استطباباتFor short procedures of less than 60 minutes:
Pediatric surgeryIn Burn patients for replacing the dressing.Repair of perineal tearsExtensive cervical tearsManual removal of placentaCesarean sectionBreast abscess drainageAs backup anesthesia if general anesthesia
inhalation apparatus fails or general anesthesia used without inhalation apparatus
Hypertension. I . C. P.Thyrotoxicosis.Eclampsia.Alcoholic.Epilepsy.Pregnancy.Glaucoma
استطباب مضادTumors of the CNS sever pre-existing
hypertension Hypersensitivity to
any component of sedation.
pulmonary disease heart disease. Refuse to consent
Postanesthesia and Emergency Care
Drugs to keep on hand for emergencies:
Apomorphine - induces vomiting Atropine sulfate - increases heart
rate Calcium gluconate - strengthens
myocardium contractions Chlorpromazine - tranquilizer Dexamethasone - steroid for
shock/anaphylaxis Doxapram - stimulates breathing
Epinephrine HCl - for asystole
Heparin - dissolves blood clots
Lactated Ringer’s - increases blood volume
Morphine HCl - analgesiaPentobarbital - anesthesiaPitocin - stimulates uterusSodium bicarbonate -
acidosisNormal saline - increases
blood volume Isoproterenol - stimulates
heart
Ketamine Anesthesia
Presentation
Supplied as clear liquid in multidose vials
Ketamine 10 mg/ml is preservative-free
50 mg/ml and 100 mg/ml with preservatives
Store in refrigerator after the vial has been opened
REFERENCES E-MEDICINE.HUMAN PHARMACOLOGY
MOLECULAR TO CLINICAL.MIDICAL PHARMACOLOGY OF KMU
UNIVERCITY.ANESTHESIA OF KMU UNIVERCITY.BRITISH NATIONAL FORMULARY.DIFFERENT INTERNET MEDICAL
SITES .
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