Ketamine (Ketalar)2

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Genral ansthetic agent

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PowerPoint Presentation:

اعوذوبلله من الشیطان الرجیم

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جمهوری اسلامی افغانستان وزارت صحت عامه ریاست شفاخانه جمهوریت دیپارتمنت جراحی عمومی موضوع کنفرانس Ketamine : استاد رهنما : ترینرمتخصص داکترسلطان محمد ” نیازی ” ترتیب کننده : داکتر محم دسمیع ٭روفي٭ ترینی سال اول جراحی عمومی شفاخانه جمهوریت . تاریخ: ۸ – ۷ - ۹۱

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GENERAL ANESTHESIA Ketamine

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Components of General Anesthesia Muscle Relaxation Unconsciousness Analgesia

Components of General Anesthesia:

Muscle Relaxation Amount of skeletal muscle relaxation requirements depend on the type of operation. Components of General Anesthesia

Components of General Anesthesia:

Analgesia / Areflexia Pain reflexes are subdued. Components of General Anesthesia

Components of General Anesthesia:

Unconsciousness/Hypnosis The patient is oblivious to all sensation but pain reflexes can occur. Components of General Anesthesia

The circle helps the anesthetist to monitor and manage::

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:

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Ketamine

Introduction:

Ketamine – I /V anesthetic Produces dissociative anesthesia: Patient is unconscious amnesic deeply analgesic as sole anesthetic agent Can also be used with muscle relaxants Introduction

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WHY WE USE KETAMINE ? WHEN WE USE KETAMINE? WHERE WE USE KETAMINE? HOW TO BE USED KETAMINE? OBJECTIVES

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WHY WE USE KETAMINE ?

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It is G/A agent. To achieve the purpose. To operate patient very safely .

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WHERE WE USE KETAMINE ?

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When every needed instrument for reanimation and recovery of the patient is available (operating room).

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HOW TO BE USED KETAMINE ?

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Produces dissociative anesthesia: unconscious amnesic deeply analgesic soluble in water Soluble in fat tissue Quickly observed Bring anesthesia very quickly. خواص کیتامین

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Total I/V anesthetic safe drug but need caution sole anesthetic agent – Can also be used with muscle relaxants

Pharmacokinetics of Ketamine Metabolism:

Pharmacokinetics of Ketamine Metabolism Metabolized by the hepatic microsomal system (CYP3A4, CYP2C9 and CYP2B6). N- demethylation ketamine norketamine (metabolite I) 19

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Norketamine (NK) has 20-30% of the ketamine activity NK hydroxlyated to Hydoxynorketamine, conjugated with glucuronate and excreted in the urine. 20

تاثیرات کیتامین بالای سیستم های عضویت:

تاثیرات کیتامین بالای سیستم های عضویت

C.N.S:

Brain vessels dilatation increased intracranial pressure hallucinations increased C . B . F C.N.S

C.V.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

R . S:

Apnea – relatively rare occurrence with ketamine – can minimize risk by giving slow IV injection Cholinergi c salivary and bronchial gland secretion Cough reflex and swallowing reflex remain positive. Pharynge al and laryngea l reflexes are usually intact: Patient can breathe on her own Good ventilatory response : Increased respiration rate and tidal volume — oxygenation is maintained R . S

Eye:

Increase intra ocular pressure Pupil reflex failure . Eye

Doseage :

For induction 1-2mg/kg/IV 4-8mg/kg/IM To continue anesthesia 1mg/kg Infusion 0.2mg/kg/min/infusion D oseage

Doses, Routes of Administration :

28 Doses, Routes of Administration

Side effectes of ketamine:

S ide effectes of ketamine serious 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 ).

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WHEN WE USE KETAMINE ?

استطبابات کیتامین:

استطبابات کیتامین For short procedures of less than 60 minutes: Pediatric surgery In Burn patients for replacing the dressing. Repair of perineal tears Extensive cervical tears Manual removal of placenta Cesarean section Breast abscess drainage As backup anesthesia if general anesthesia inhalation apparatus fails or general anesthesia used without inhalation apparatus

مضاد استطباب:

Hypertension . I . C. P . Thyrotoxicosis . Eclampsia . Alcoholic . Epilepsy . Pregnancy . Glaucoma مضاد استطباب Tumors of the CNS s ever pre-existing hypertension Hypersensitivity to any component of sedation. pulmonary disease heart disease. Refuse to consent

Postanesthesia and Emergency Care:

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 - analgesia Pentobarbital - anesthesia Pitocin - stimulates uterus Sodium bicarbonate - acidosis Normal saline - increases blood volume Isoproterenol - stimulates heart

Presentation:

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 :

References E-MEDICINE. HUMAN PHARMACOLOGY MOLECULAR TO CLINICAL. MIDICAL PHARMACOLOGY OF KMU UNIVERCITY. ANESTHESIA OF KMU UNIVERCITY. BRITISH NATIONAL FORMULARY. DIFFERENT INTERNET MEDICAL SITES .

دتوجه نه مو مننه:

دتوجه نه مو مننه وَمَا عَلَيْنَا إِلاَّ الْبَلاَغُ

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