Phenobarbital liver in the absence of other drugs, produces only modest decreases in hepatic blood flow. Induction doses of thiopental do not alter postoperative liver function tests. Barbiturates increase hepatic bile flow. However, there is no correlation between the increase in bile flow and the cytochrome P-450 concentration in the liver. Thiopental decreases intraocular pressure […]
Etomidate mechanism of action is shown here. The GABAA receptor plays a central role in the etomidate mechanism of action Etomidate exerts its effects on the receptor by binding directly to a specific site or sites on the protein and allosterically enhancing the apparent affinity of GABA for its receptor. At much higher concentrations etomidate
Aging and liver disease affect glucuronidation less than oxidative metabolic pathways. And thus, lorazepam, oxazepam, benzodiazepines in the elderly and temazepam are preferentially used in elderly patients over other benzodiazepines as they are metabolized only by glucuronidation and have no active metabolites. Elderly patients may also be intrinsically sensitive to benzodiazepines, suggesting that the enhanced
Hypnotherapy placebo effect therapy most probably acts via, placebo effects/auto suggestion mechanisms. Anaesthesiologists have been practicing some form of suggestion therapy even in their day-to-day preoperative visits on the eve of surgery. Even a 5-minute preoperative visit will reduce anxiety of patient significantly. Hypnotherapy placebo effect or what was called mesmerism was described in late
Propofol is an insoluble drug that requires a lipid vehicle for emulsification. The standard propofol emulsion formulation contains 10% soya oil as the oil phase and egg lecithin as the emulsifying agent that is composed of long-chain triglycerides. This formulation supports bacterial growth new formulations contain preservatives with bactericidal action, such as propofol with EDTA
Halogenated volatile agents are inhalational anesthesia gases used during surgeries to provide general anesthesia. They are metabolized to varying degrees. There is biotransformation in the liver resulting in cleavage and dehalogenation by the specific enzyme P450, which is a haemocytochrome present in the hepatic cell. Desflurane (CHF2-O-CHFCHF3): It is one of the halogenated volatile agents
Midazolam produces dose-dependent decrease in ventilation with 0.15 mg/kg IV producing effect similar to diazepam 0.3 mg/kg IV. Patients with chronic obstructive pulmonary disease experience even greater midazolam respiratory depression . Transient apnoea usually follows after rapid injection of large doses of midazolam (>0.15 mg/kg IV) especially in the presence of premedication with opioids. The
Propofol and egg allergy are quietly related as one of the side effects. Allergic reactions to propofol on first exposure are usually because of the isopropyl groups that may act as epitopes and that are present in various medications andcosmetics. Allergic reactions to propofol upon re-exposure are usually because of the phenol molecule. Propofol and
Ketamine respiratory depression is considered to be the ideal anesthetic for asthmatic patients because it decreases the risk of bronchospasm during induction of anesthesia and preserves the pulmonary vasoconstriction reflex to hypoxia. It does not produce significant depression of ventilation. The ventilatory response to carbon dioxide is maintained during ketamine respiratory depression anesthesia. The respiratory
Midazolam use is helpful with hypnotic amnesic during maintenance of general anesthesia. It proved superior to thiopental because fewer adjuvant anesthetics are required to maintain an acceptable depth of anesthesia. Midazolam use , however, cannot be implemented alone to maintain adequate anesthesia. It may be used with inhalational drugs as well. The MAC of halothane
