1. Moderator:Dr vijesh Presenter:Dr Nikhil M P Thiopentone Ketamine Propofol

2. Chemical structure

3. 0 Cl NHCH3 N O S CH3CH2 N CH3CH2CH2CH CH3 OH (CH3)2CH CH(CH3)2 Arylcyclohexylamine(phencyclidine) Thiobarbiturate Alkylphenol Ketamine Thiopentone Propofol

4. Physico-chemical characteristics

5. FORMULATIONS

6. Propofol Thiopentone Ketamine 1%,2%,10% solution Yellow amorphous powder 500mg,1 g 1%,2% & medium,long Chain Triglycerides Clear aqueous solution sodium salts (6% sodium carbonate by wt) emulsion milky white

7. Cont…. 7.5 7.6 pka - 11 3.5 TO 5.5 10.5 of 2.5% solution pH -7 lipid soluble lipid soluble lipid soluble

8. Metabolism

10. Cont……… absent absent Extrahepatic- lungs norketamine- 20 to 30% inactive metabolites- inactive

11. Pharmacokinetics

12. 10 to 20min 5 to 10 min 5 to 10 min awakening 90 to 100 s 90 to 100 s 90 to 100 s peak do do one arm brain circulation onset Ketamine Thiopentone Propofol

13. redistribution redistribution Redistribution & Elimination Rapid fall in Plasma conc after single bolus

14. Cont…… 3L/kg 1.5 to3L/kg 2 to 10L/kg Volume of distribution (12 to 14 ml/kg/min) (3 to 4 ml/kg/min) (20 to 30 ml/kg/min) clearance 2 to 3 hrs 7 to 17 hrs 1 to 3 hrs Elimination Half life Ketamine Thiopentone Propofol

15. < 40 min < 150 min < 40 min Context Sensitive Half time (for infusions lasting upto 8 hrs) Ketamine Thiopentone Propofol

16. MOA

17. NMDA thalamocortical& limbic system GABA GABA Ketamine Thiopentone Propofol

18. CNS

19. sed sed sed ICP sed sed sed CBF sed sed (55%) sed ( 36%) CMRO2 Ketamine Thiopentone Propofol

21. Cont ….. + -- -- Upper airway reflexes + -- -- Emergence reactions + -- _ Dissociative anaesthesia Ketamine thiopentone propofol

22. Cont…. + -- -- Nystagmus sed -- -- Skeletal muscle tone ++ -- -- Salivation& Lacrimation ketamine thiopentone propofol

23. CVS

24. sed sed sed Cardiac output sed sed ( 10 to 36 %) Inhibits tacycardic response to hypotension Heart rate sed sed sed (25 to 40 %) Arterial BP Ketamine Thiopentone Propofol

25. RS

26. + -- + Bronchodilatation sed sed sed Minute ventilation higher doses ++ ++ Dose dependant ( 25 t0 30%) Apnea Ketamine Thiopentone Propofol

27. Doses

28. 0.2 to0.8 mg/kg IV 2 to 4mg/kg IM 25 to 75mic/kg/min sedation 15 to 45 mic/kg/min IV–N2O 30 TO 90 mic/kg/min 50 to 150 mic/kg/min maintenance 0.5 to 2 mg/kg IV 4 to 6mg/kg IM 3 to 5 mg/kg IV 1 to 2.5 mg/kg IV induction ketamine thiopentone propofol

29. Cont… -- -- 10 to 20 mg IV or 10mic/kg/min Antiemetic 0.2 to 0.8 IV -- -- Analgesia

30. uses

31. + -- + Sedation + + ++ Maintenance + + + Induction Ketamine Thiopentone Propofol

32. Cont…… -- -- + Antiemetic + -- -- Pre-emptive analgesia + -- -- Analgesia Ketamine Thiopentone Propofol

33. Cont…. -- -- + Chronic refractory headache -- + + Anticonvulsant -- -- + Antipruritic

34. Side effects

35. +/-- + ++ Apnea -- + ++ Hypotension -- + ++ Pain on injection Ketamine Thiopentone Propofol

36. Cont…. -- ++ + Thrombophle bitis + -- -- Emergence reaction -- + + Allergic reactions -- + -- Broncho spasm

38. thank you