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اسالمی جمهوریافغانستان

عامه وزارتصحتجمهوریت شفاخانه ریاست

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

19

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

28

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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