Module 9 - Classification of Anesthetics

1. Inhalant

2. Parenteral

Classification of Anesthetics

1. Major Inhalant Anesthetics (3)

2. Minor Inhalant Anesthetic (2)

3. Other Inhalant Anesthetic (3)

4. New Inhalant Anesthetics (4)

Classification of Inhalant anesthetics

Inhalant Anesthetics - is in the form of gas or vapors via inhalation route.

_______ Anesthetics - is in the form of gas or vapors via inhalation route.

Inhalant Anesthetics - is in the form of gas or vapors via inhalation route.

Inhalant Anesthetics - is in the form of ___ or _____ via ______ route.

1. Methoxyflurane

2. Halothane

3. Nitrous Oxide

Mi-Halo-Na

Class of Major Inhalant Anesthetics

Methoxyflurane

• Considered to be most popular inhalant anesthetic used in small animal in the old-old-days.

• It is more potent than halothane and nitrous oxide.

• In horses, improper administration causes unwanted and prolong recovery.

• It bypasses Stage II, therefore it will not show signs of stage II it will go directly to stage III.

Methoxyflurane

• Considered to be most ______ inhalant anesthetic used in ____ animal in the old-old-days.

• It is more ____ than halothane and nitrous oxide.

• In horses, improper _________ causes unwanted and prolong ______.

• It bypasses Stage II, therefore it will not show ____ of stage II it will go directly to stage ___.

Methoxyflurane

• Considered to be most popular inhalant anesthetic used in small animal in the old-old-days.

• It is more potent than halothane and nitrous oxide.

• In horses, improper administration causes unwanted and prolong recovery.

• It bypasses Stage II, therefore it will not show signs of stage II it will go directly to stage III.

__________

• Considered to be most popular inhalant anesthetic used in small animal in the old-old-days.

• It is more potent than halothane and nitrous oxide.

• In horses, improper administration causes unwanted and prolong recovery.

• It bypasses Stage II, therefore it will not show signs of stage II it will go directly to stage III.

Cardiac arrhythmia occurs, but can be abolish by atropine.

Methoxyflurane

Side effect

Methoxyflurane

Drug Interaction: Administration of Epinephrine can cause arrhythmia during methoxyflurane anesthesia.

Methoxyflurane

Drug Interaction: Administration of _______ can cause _______ during methoxyflurane anesthesia.

epinephrine

If you administer this during methoxyflurane anesthesia, it will cause arrhythmia.

Halothane

• In I960, it is the most popular anesthetic in human now it is enflurane.

• By-pass Stage II

Halothane

• In _____, it is the most popular anesthetic in _____ now it is _____.

• By-pass Stage __

enflurane

Most popular anesthetic after halothane (70s-80s)

Halothane

Contraindications:

Ø Do not use Halothane when performing Neurosurgery, because it produces more CSF.

Ø Halothanes is poor choice anesthetic for patients with heart disease

Halothane

Contraindications:

Ø Do not use Halothane when performing ______, because it produces more ____.

Ø Halothanes is poor choice anesthetic for patients with _____ disease

1. Do not use Halothane when performing Neurosurgery, because it produces more CSF.

2. Halothanes is poor choice anesthetic for patients with heart disease

Contraindications of Halothane?

Apnea – breathing stop while asleep or almost no airflow

Tachypnea – rapid breathing

____ – breathing stop while asleep or almost no airflow

______ – rapid breathing

Halothane

Side Effects/Adverse Effects:

• Causes Apnea and Apnea can be decrease by pre-anesthetic of barbiturate

• It cause tachypnea and can be abolish by meperidine

• It depress the thermoregulatory mechanism (leading to hypothermia)

• Can cause Hepatitis especially when the ALT level is in the maximum range.

Halothane

Side Effects/Adverse Effects:

• Causes _____ and ____ can be decrease by pre-anesthetic of _____

• It cause _____ and can be abolish by ______

• It depress the _______ mechanism (leading to ______)

• Can cause _____ especially when the ___ level is in the maximum range.

1. cause apnea, decrease by barbiturates

2. cause tachypnea, abolish by meperidine

3. depress thermoregulatory mechanism > hypothermia

4. maximum ALT level > hepatitis

ATHH(lit)

Halothane side effects, make it short

Halothane

Drug interaction:

• Administration of Epinephrine may result to risk of arrythmia and ventricular fibrillation.

• Hepatotoxicity (liver poisoning) is enhanced by Acetaminophen in UK (Paracetamol in US).

• When you use Halothane do not give Aminoglycosides to the animal due to muscle contraction

• Do not give Phenobarbital and Halothane causes Hepatitis.

Halothane

Drug interaction:

• Administration of ______ may result to risk of ______ and _____ ______.

• _______ (liver poisoning) is enhanced by ______ in UK (______ in US).

• When you use Halothane do not give ________ to the animal due to ____ contraction

• Do not give ______ and _____ causes ______.

Drug interaction in halothane:

• administer epinephrine > risk of arrhythmia and ventricular fibrillation

• hepatotoxicity > enhanced by acetaminophen/paracetamol

• do NOT give aminoglycosides (due to muscle contraction)

• together with phenobarbital and halothane > hepatitis

Drug interaction in halothane:

• administer ______ > risk of arrhythmia and ventricular fibrillation

• hepatotoxicity > enhanced by ______/_______

• do NOT give _______ (due to muscle contraction)

• together with ______ and ______ > hepatitis

Drug interaction in halothane:

• administer epinephrine > risk of arrhythmia and ventricular fibrillation

• hepatotoxicity > enhanced by acetaminophen/paracetamol

• do NOT give aminoglycosides (due to muscle contraction)

• together with phenobarbital and halothane > hepatitis

Drug interaction in halothane:

• administer epinephrine > risk of _____ and ______ _____

• _______ > enhanced by acetaminophen/paracetamol

• do NOT give aminoglycosides (due to _____ contraction)

• together with phenobarbital and halothane > ______

AHMH

Drug interaction in halothane:

• administer epinephrine > risk of arrhythmia and ventricular fibrillation

• hepatotoxicity > enhanced by acetaminophen/paracetamol

• do NOT give aminoglycosides (due to muscle contraction)

• together with phenobarbital and halothane > hepatitis

Drug interaction in halothane:

Halothane

• improper storage > decomposition by sunlight

• Drug companies adds Thymol to Halothane to reduce decomposition

Halothane

• improper storage > _______ by sunlight

• Drug companies adds _____ to Halothane to reduce ______

Drug companies adds Thymol to Halothane to reduce decomposition

Drug companies adds _____ to Halothane to reduce decomposition

Nitrous Oxide - Only inhalant anesthetic recommended for maintenance of ketamine anesthesia (especially in humans).

______ _____ - Only inhalant anesthetic recommended for maintenance of ketamine anesthesia (especially in humans).

Nitrous Oxide - Only inhalant anesthetic recommended for maintenance of ketamine anesthesia (especially in humans).

Nitrous Oxide - Only inhalant anesthetic recommended for ______ of _____ anesthesia (especially in humans).

Nitrous Oxide

Contraindications:

• Has affinity with oxygen, oxygen binding from tissues causes cyanosis.

• Animal with emphysema, there is a difficulty expelling air from the lungs.

• Animal with pneumothorax, air in the thoracic cavity.

• Animal with pneumoperitoneum, air in the abdominal cavity.

• In Cattle (gas diffuse in ruminal space)

Nitrous Oxide

Contraindications:

• Has affinity with _____, oxygen binding from tissues causes _____.

• Animal with ______, there is a difficulty expelling ___ from the _____.

• Animal with ______, air in the _____ cavity.

• Animal with ________, air in the ______ cavity.

• In Cattle (___ diffuse in _____ space)

Nitrous Oxide contraindications

• has affinity with oxygen > oxygen binding in tissues > cyanosis

• animal with emphysema

• animal with pneomothorax

• animal with pneumoperitoneum

• in cattle, gas diffuse in ruminal space

CEPPR

Nitrous Oxide contraindications

• has affinity with oxygen > oxygen binding in tissues > ______

• animal with _______

• animal with _________

• animal with ___________

• in cattle, gas diffuse in ______ space

1. Ether

2. Chloroform

minor lang yan eh, EC (pc)

Classes of Minor Inhalant Anesthetic

Ether - Oxidase in air, moisture, and light, thus forming peroxides.

_____ - Oxidase in air, moisture, and light, thus forming peroxides.

Ether - Oxidase in air, moisture, and light, thus forming peroxides.

Ether - ______ in air, moisture, and light, thus forming _____.

Ether Side effects

• It depresses metabolism of aminopyrines in rat.

• Nausea and vomiting is a complication of light etherisation

• Inhibit uridine diphosphoglucoronyl transferase, an enzyme responsible for transfer glucuronic acid to uridine diphosphoglucuronic acid

Ether Side effects

• It depresses ______ of ______ in ___.

• ______ and _____ is a complication of light _____

• Inhibit ______ __________ _______, an enzyme responsible for transfer glucuronic acid to uridine diphosphoglucuronic acid

Ether Drug Interaction:

• Neomycin (antibiotic, aminoglycosides) should not be given to the patient that is given Ether as anesthetic, such may cause death in human.

Ether Drug Interaction:

• ________ (antibiotic, aminoglycosides) should not be given to the patient that is given Ether as anesthetic, such may cause _____ in human.

Ether Contraindications:

• Pneumonia and other respiratory disease

Ether Contraindications:

• ______ and other _____ disease

Ether Storage:

• Improper storage causes explosion.

Ether Storage:

• Improper storage causes ______.

Chloroform - Used as euthanizing agent

_________ - Used as euthanizing agent

Chloroform other uses

• Solvent industry

• Production of antibiotics

• Cleaning agents

Chloroform other uses

• ______ industry

• Production of _____

• ______ agents

• Solvent industry

• Production of antibiotics

• Cleaning agents

Chloroform other uses

1. Ethyl Chloride

2. Carbon dioxide

3. Tricaine Methane Sulfonate

Other or ETC.

Classes of Other Inhalant Anesthetic

Ethyl Chloride - Better to be used in industrial companies

_____ _______ - Better to be used in industrial companies

Ethyl Chloride - Better to be used in industrial companies

Ethyl Chloride - Better to be used in _____ companies

Carbon dioxide

- Used as Euthanizing agent in food producing animals especially in slaughterhouses.

- The residue of carbon dioxide is easily excreted.

Carbon dioxide

- Used as _______ agent in ____ producing animals especially in _______.

- The ______ of carbon dioxide is easily ______.

Carbon dioxide

- Used as Euthanizing agent in food producing animals especially in slaughterhouses.

- The residue of carbon dioxide is easily excreted.

______ ______

- Used as Euthanizing agent in food producing animals especially in slaughterhouses.

- The residue of carbon dioxide is easily excreted.

Tricaine Methane Sulfonate - Anesthetic recommended in fishes especially in transporting (long distance).

Tricaine Methane Sulfonate - Anesthetic recommended in _____ especially in ________ (long distance).

Tricaine Methane Sulfonate - Anesthetic recommended in fishes especially in transporting (long distance).

______ ______ _______ - Anesthetic recommended in fishes especially in transporting (long distance).

• enflurane

• isoflurane

• sevoflurane

• aliflurane

(enami) EISA

Classes of NEW Inhalant anesthetics

Eflurane

Side effects

• Convulsant anesthetics (produces seizures) there causes muscle twitching, which could be a treated with Thiopental/ Thiamylal/ Diazepam.

Eflurane

Side effects

• _________ anesthetics (produces ______) there causes muscle _____, which could be a treated with Thiopental/ Thiamylal/ Diazepam.

Thiopental/ Thiamylal/ Diazepam

Eflurane side effects

• Convulsant anesthetics (produces seizures) there causes muscle twitching, which could be a treated with?

Enflurane contraindications

• should not be used in neurosurgery

Enflurane contraindications

• should not be used in _______

Enflurane drug interaction

• Thiamylal and Enflurane anesthesia decrease body temperature.

Enflurane drug interaction

• ______ and ______ anesthesia ______ body temperature.

Enflurane

• Side effects: convulsant anesthetics > seizures and muscle twitching (treated with Thiopental/ Thiamylal/ Diazepam)

• Contraindications: NOT used in neurosrugery

• Drug interaction: Thiamylal and Enflurane anesthesia decrease body temperature

Enflurane

• Side effects

• Contraindications

• Drug interaction

Isoflurane

• Side effect: Triggers malignant hyperthermia in swine

• Drug Interaction: Enhance the action of Succinylcholine

• Indication/Use: Smooth recovery is advantageous in horses.

Isoflurane

• Side effect: Triggers ______ ______ in swine

• Drug Interaction: Enhance the action of ________

• Indication/Use: _______ recovery is advantageous in horses.

Triggers malignant hyperthermia in swine

Isoflurane side effect

Enhance the action of Succinylcholine

Isoflurane drug interaction

Smooth recovery is advantageous in horses.

Isoflurane use

• Vapors are gaseous state anesthetics but ambient temperature and pressure is liquid. (ex. Halothane, Isoflurane, Desflurane, Sevoflurane, Methoxyflurane, Enflurane.

• Gaseous exist in gaseous form at room temperature and sea level pressure. (ex. Nitrous Oxide)

Note

1. Barbiturates

2. Chloral hydrate

3. Chloral hydrate + MgSO4

4. Chloral hydrates + MgSO4 + pentobarbital

5. Guaifenesin

6. Althesin (Saffan/Safaxan)

7. Dissociative Anesthetics

8. Miscellaneous Agents

Classifications of Parental Anesthetics (BCCC) (GADM)

(BC³- GhADeyM)

Barbiturates

Under Parental Anesthetics, it is White powder, except the sulfate containing which are yellow powder.

Barbiturates - White powder, except the sulfate containing which are yellow powder.

________ - White powder, except the sulfate containing which are yellow powder.

1. Long acting

2. Intermediate acting

3. Short acting

4. Ultra- Short acting

Kinds of Barbiturates (LISU)

Long acting = Phenobarbital (3hrs or more)

Long acting = ________ (3hrs or more)

Intermediate acting = Amobarbital (more or less 2 hours)

Intermediate acting = __________ (more or less 2 hours)

Short acting = Pentobarbital, Secobarbital (1 hour)

Short acting = Pentobarbital, _________ (1 hour)

Ultra-short acting = Thiopental, Thiamylal, Thialbarbital, Methohexital, Hexobarbital (normally used as pre-anesthetic)

Ultra-short acting = Thiopental, ________, Thialbarbital, _______, Hexobarbital (normally used as _______)

-th, yellow powder

Sulfur-containing barbiturates are the drugs that starts with ___ and are _________(ex. Thiopental, Thiamylal, Thialbarbital).

Barbiturates
Contraindications:

Ø Barbiturates slightly depresses respiratory system except in cats.

Ø Animal (esp. in Ruminants) with Congenital Porphyrin Condition (pink tooth) which is an infectious disease from the Dam, barbiturates should not be given.

Barbiturates
Contraindications:

Ø Barbiturates slightly _______ respiratory system except in cats.

Ø Animal (esp. in Ruminants) with Congenital _______ _______(pink tooth) which is an infectious disease from the Dam, barbiturates should not be given.

Barbiturates
Contraindications:

Ø Clearance of phenobarbital is greater in alkaline than in acidic urine.

Ø Breed and strains of animal are more sensitive to barbiturates.

Barbiturates
Contraindications:

Ø Clearance of phenobarbital is _____ in alkaline than in _____ _____.

Ø Breed and strains of animal are ____ _____ to barbiturates.

Barbiturates

Drug Interaction:

Ø Re-anesthetization occurs in Thiopental due to following drugs:

• Epinephrine

• Isoproterenol

• Aspirin (pain reliever)

• Phenylbutazone (pain reliever)

Ø Anesthetics-Antibiotics Interaction:

• Cats anesthetized with Phenobarbital, neomycin induces complete paralysis.

• Dog recovering with pentobarbital, dihydrostreptomycin causes apnea and death

• Animal receiving chloramphenicol, pentobarbital should not be used for at least 25 days.

Barbiturates

Drug Interaction:

Ø Re-anesthetization occurs in ________ due to following drugs:

• __________

• Isoproterenol

• Aspirin (pain reliever)

• Phenylbutazone (pain reliever)

Ø Anesthetics-Antibiotics Interaction:

• Cats anesthetized with __________, neomycin induces ______ _______.

• Dog recovering with _________, dihydrostreptomycin causes ______ and _____

• Animal receiving __________, pentobarbital should not be used for ___________.

• Chloramphenicol should not be given to animals that are for food consumption because it causes Anemia.

Note

Oxybarbiturates

Barbiturates with oxygen

a. Methohexital

b. Secobarbital

c. Hexobarbital

Kinds/types of Oxibarbiturates (MSH) (MaSaHe)

Animal with barbiturates be kept warm eplemic sequestration of RBC Oxybarbiturates should be not to be used for splenectomy due to reanesthetizing action recovering from barbiturates with glucose solution for fluid therapy (glucose effect).

Animal with barbiturates be kept warm _______ ________ of RBC Oxybarbiturates should be not to be used for _______ due to _______ action recovering from barbiturates with glucose solution for ____ _____(glucose effect).

Chloral hydrate

Was 1st introduced as a hypnotic agent, before it become a CNS depressant

Chloral hydrate

Good hypnotic, but poor anesthetics because of its narrow margin of safety (slight change may be toxic).

Chloral hydrate
Side Effects:

Ø Vomiting occurs in carnivores because of gastric irritation, this is corrected with presence of food in the stomach

Ø Depressant effect is limited to cerebrum

Chloral hydrate
Side Effects:

Ø Vomiting occurs in ______ because of ______ ______, this is corrected with presence of food in the stomach

Ø Depressant effect is limited to ________

Chloral hydrate + MgSO4

Mixture: Ø 12% CH (Hypnotic)

Ø 6% MgSO4 (muscle relaxant)

Chloral hydrate + MgSO4

Mixture: Ø ____ ___ (Hypnotic)

Ø ____ MgSO4 (muscle relaxant)

Chloral hydrate + MgSO4

Administration at a rate of 30 ml/min. and stop when stage of surgical anesthesia appears.

Chloral hydrate + MgSO4

Administration at a rate of ___ ___/___. and stop when stage of ______ _______ appears.

Chloral hydrate + MgSO4

Side Effects:

Ø CH depress the CNS

Ø MgSO4 is a muscle relaxant

Chloral hydrate + MgSO4

Side Effects:

Ø CH _____ the _____

Ø MgSO4 is a ______ _______

Chloral hydrate + MgSO4

Never use MgSO4 as euthanizing agent, because animal will still suffer.

Chloral hydrate + MgSO4

______ use MgSO4 as _______ agent, because animal will still ____.

Chloral hydrates + MgSO4 + pentobarbital

Mixture in 1000 ml of H2O

Ø 30g CH

Ø 15 MgSO4

Ø 6.6g Pentobarbital

Chloral hydrates + MgSO4 + pentobarbital

Mixture in 1000 ml of H2O

Ø ___ CH

Ø ___ MgSO4

Ø 6.6g ________

Chloral hydrates + MgSO4 + pentobarbital

Pentobarbital can’t be added to the solution unless it is to be within 1 hour.

Chloral hydrates + MgSO4 + pentobarbital

Pentobarbital can’t be added to the solution unless it is to be within __ ____.

Guaifenesin

Formerly known as Glyceryl guaiacolate

Guaifenesin

Analgesic, antipyretic (sinat) and expectorant (robitussin is one of the brand name)

Guaifenesin

Analgesic, _______ (sinat) and _______ (robitussin is one of the brand name)

Guaifenesin

In horses, it is used as muscle relaxant

Guaifenesin

In horses, it is used as _____ ______

Guaifenesin

Some bactericidal and bacteriostatic properties

Guaifenesin

Some _______ and _________ properties

Althesin (Saffan/Safaxan)

Steroidal preparation for induction of anesthesia

Althesin (Saffan/Safaxan)

Contains 2 Pregnanediol:

• Alphaxalone acetate (Steriod I)

• Alphadolane acetate (Steroid II)

Althesin (Saffan/Safaxan)

Contains 2 Pregnanediol:

• ________ acetate (Steriod I)

• ________ acetate (Steroid II)

Althesin (Saffan/Safaxan)

Side Effects:

Ø Produce severe arterial hypotension in dog and cat, but not in sheep,pig, rabbit and human

Ø In dog, cause release of histamine, which leads to cardiovascular collapse

Althesin (Saffan/Safaxan)

Side Effects:

Ø Produce severe _______ _________ in dog and cat, but not in sheep,pig, rabbit and ______

Ø In dog, cause release of_______, which leads to __________ collapse

Althesin (Saffan/Safaxan)

Drug Interaction:

Ø Barbiturates is contraindicated with Althesin.

Althesin (Saffan/Safaxan)

Drug Interaction:

Ø Barbiturates is contraindicated with ______.

1. Phencyclidine HCl

2. Ketamine HCl

3. Tiletamine

Types of Dissociative Anesthetics (PKT) (PiKiT)

Phencyclidine HCl

- Differs from general anesthesia in that absence of pain stimuli is not accompanied by loss of corneal, papillary reflexes.

- Induce catalepsy

- Induce stage 1 and 2 (Light Surgical Anesthesia) but not stage 3

- Decrease dose produce depression but increase dose produce excitation

Phencyclidine HCl

- Differs from ______ anesthesia in that absence of pain stimuli is not accompanied by loss of _______, papillary reflexes.

- Induce ________

- Induce stage 1 and 2 (Light Surgical Anesthesia) but not _____ __

- Decrease dose produce ________ but increase dose produce _______

Ketamine HCl

• Ketamine is more commonly used in combination with other anesthetics (nitro oxide, muscle relaxants)

• From Ketamine to Ecstasy, the reasons what it is no longer used.

• Induces stage I and II (Light Surgical Anesthesia), but not stage III

• Referred to as epileptogenic anesthetic (anticonvulsant), can be corrected.

Ketamine HCl

• Ketamine is more commonly used in _______ with other anesthetics (nitro oxide, muscle relaxants)

• From Ketamine to Ecstasy, the reasons what it is no longer used.

• _______ stage I and II (Light Surgical Anesthesia), but ___ stage III

• Referred to as _______ anesthetic (________), can be corrected.

Ketamine HCl

• It lacks cardiorespiratory depression

• Potent inhibitor of GABA (neurotransmitter in the brain)

• Blocks the neuronal transport of serotonin, dopamine, norepinephrine

• In asthmatic patients, aminophylline can be administered before or during ketamine anesthesia

Ketamine HCl

• It lacks __________ depression

• Potent inhibitor of _____ (neurotransmitter in the brain)

• ______ the neuronal transport of serotonin, dopamine, norepinephrine

• In asthmatic patients, _________ can be administered before or _______ ketamine anesthesia

Ketamine HCl

• If used as mono-anesthetics, pharyngeal and laryngeal reflex remain

• With the combination ketamine (anesthetic)-xylazine (muscle relaxant), nystagmus remain (corrected with ketamine-halothane mixture).

Ketamine HCl

• If used as ____-_______, pharyngeal and laryngeal reflex ______

• With the combination ketamine (anesthetic)-xylazine (muscle relaxant), ________ remain (________ with ketamine-halothane mixture).

Ketamine HCl

Drug Interaction:

Ø Thyroid hormone and ketamine, in patients with thyroid treatment develop hypertension and tachycardia

Ketamine HCl

Drug Interaction:

Ø _______ hormone and ketamine, in patients with thyroid treatment develop _________ and _________

Ketamine HCl

Contraindications:

Ø Not to be used in animal intended for human consumption

Ø Sole used of ketamine for abdominal and orthopedic surgery is not recommended.

Ø In heart diseases

Ø In liver and kidney disease

Ø Head injuries

Ø Precaution to control hemorrhage

Ketamine HCl

Contraindications:

Ø Not to be used in animal intended for ______ __________

Ø Sole used of ketamine for ________ and ________ surgery is not recommended.

Ø In ____ diseases

Ø In _____ and _____ disease

Ø Head injuries

Ø Precaution to ______ __________

Tiletamine

Approved for dogs and cats in combination with zolazepam.

Tiletamine

- Approved for dogs and cats in combination with zolazepam.

- Duration of action 3x longer that ketamine. (Tiletamine + Zolazepam)

- Chloramphenicol increase the duration of anesthesia in cat but not in dog.

Tiletamine

- Approved for dogs and cats in combination with_______.

- Duration of action __ longer that ketamine. (Tiletamine + Zolazepam)

- Chloramphenicol ________ the duration of anesthesia in cat but not in ____.

Miscellaneous Agents

1. Chloralose

2. Urethane

3. Propanidid

4. Metomidate

5. Etomidate

6. Propofol

Miscellaneous Agents (CUPMEP) (Come-Up-Pay-ME-Please)

Chloralose

Miscellaneous Agents

Produced by condensing anhydrous glucose with chloral hydrate in the presence of sulphuric acid.