general anesthesia.ppt

Etomidate Disadvantages: No analgesic effects. Myoclonus after administration. Adrenal suppression. Muscle Relaxant Neuromuscular junction Nerve terminal Motor endplate of a muscle Synaptic cleft Nerve stimulation Release of Acetylcholine Postsynaptic events Binding of Ach to receptors on muscle end-plate Muscle relaxants Depolarizing muscle relaxant Succinylcholine Nondepolarizing muscle relaxants Short acting Intermediate acting Long acting Depolarizing Muscle Relaxant Succinylcholine What is the mechanism of action? Physically resemble Ach Act as acetylcholine receptor agonist Not metabolized locally at NMJ Metabolized by pseudocholinesterase in plasma Depolarizing action persists Ach Continuous end-plate depolarization causes muscle relaxation Depolarizing blockade Muscle fasciculation followed by relaxation Potentiation of the block by anticholinesterases Repeated or continuous administration of SCh cause phase Ⅱ block Side effects of SCh Cardiovascular Fasciculation Muscle pain Increase intraocular pressure Increase intragastric pressure Increase intracranial pressure Hyperkalemia Malignant hyperthermia Nondepolarizing Muscle Relaxants What is the mechanism of action? Compete with Ach at the binding sites Do not depolarized the motor endplate Act as competitive antagonist Excessive concentration causing channel blockade Act at presynaptic sites, prevent movement of Ach to release sites Nondepolarizing Muscle Relaxants Long acting Pancuronium Intermediate acting Atracurium Vecuronium Rocuronium Cisatracurium Short acting Mivacurium Nondepolarizing blockade Absence of muscle fasciculations Reversible by anticholinesterases Muscle relaxant Muscle relaxants must not be given without adequate dosage of analgesic and hypnotic drugs Inappropriately given : a patient is paralyzed but not anesthetized Atracurium and Mivacurium can produce histamine release Contraindications of SCh Severe skeletal muscle trauma Unhealed third-degree burns Paresis o