✨Anesthesia✨

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هاي السلايدات اساسيات البدء بالعملية يجي المريض للصالة وينام عالcouch مال العمليات وانت وياه بالصالة لازم تعرف شنو تحجي وياه، شنو تسأله، شنو تفحصه وتشوف وتتاكد منه عبالكم التخدير سرنجتين وصونده؟؟ الخطورة والمصيبة هي من تنطي تخدير لمريض وانت متعرف شبيه مابيه

2	كم واحد بيكم قره السلايدات؟ محد!! بالاخير راح تبجون دم بالثالثة على ضياع الوقت هذا	307
3	+4 No text...	494
4	+9 اريدكم تراجعون هاي المحاضرة حتى نتناقش بيها (ملغومة للستار)	461
5	البروبوفول عنده توقيتات ثنين الاولى: هي الفعالية الثانية: هي الخروج من الجسم بالبداية لازم نعرف شنو مصطلح half-life نضرب مثلا انطينا جرعة بروبوفول ونسبتها بالدم 100% وره 30 دقيقة راح تقل النسبة للنصف يعني 50% الكمية المتبقية فعالة، اوكي؟ وره 30 دقيقة ثانية، ال50% المتبقية الفعالة راح تقل للنصف، ويبقى 25% فعالة وره 30 دقيقة اخرى، يبقى 12.5% وره 30 دقيقة اخرى يبقى 6.25%، وهكذا.. تقريبا 5 الى 6 مرات حتى توصل للصفر هذه العملية ثابتة لكل الادوية الكبد هو اللي يقوم بعملية ابطال مفعول الادوية في اغلب الاحيان، يعني بحالة البروبوفول راح يبطل مفعول البروبوفول ويحوله الى مادة "غير فعالة" مالها اي تأثير على الجسم، ومجرد تفتر بالجسم الى ان تفرز خارج الجسم اللي هو يطول بين 3- 5 ساعات	353
6	منو يعرف الجواب؟؟	349
7	✨Pancuronium Bromide✨ ⛔ It is a non-depolarizing MR ⛔ Used for endotracheal intubation, surgery and mechanical ventilation ⛔ Act as a competitive agonist on nicotinic receptor on neuromuscular endplate ♣️Dosage♣️ ▶️ Intubationg dose: 0.1 mg/kg IV 🔴Pharmacology🔴 🔰 Its a long acting MR 🔰 Protein binding: 75-90% 🔰 Onset of action: 4-6 minutes 🔰 Duration: 60-120 minutes 🔰 Metabolized by liver 🔰 Excreted renally ⛔Side Effects⛔ 💠 Tachycardia 💠 Hypertension: due to release of Calcium ions 💠 Hypersensitivity reactions: rash, itching, erythema 💠 Excessive salivation 💠 Bronchspasm and wheezing 💠 Profound weakness	337
8	✨Atracurium✨ ⛔ It is a non-depolarizing MR ⛔ Used for endotracheal intubation, surgery and mechanical ventilation ⛔ Act as a competitive agonist on nicotinic receptor on neuromuscular endplate ♣️Dosage♣️ ▶️ Intubation dose: 0.4-0.5 mg/kg 🔴Pharmacology🔴 🔰 Its an intermediate acting MR 🔰 Onset: 3-5 minutes 🔰 Duration: 30-45 minutes 🔰 Metabolism: hydrolysis by non-specific esterase (Hofmann elimination) 🔰 Protein binding: 82% 🔰 Elimination Half-life: 17-21 minutes ⛔Side Effects⛔ 💠 Hypersensitivity reactions: skin flush, erythema, pruritis 💠 Histamine release 💠 Bronchospasm, wheeze 💠 Increased bronchial secreations 💠 Hypotension 💠 Change in heart rate	240
9	✨ Rocuronium✨ ⛔ It is a non-depolarizing MR ⛔ Used for endotracheal intubation, rapid sequence induction, mechanical ventilation and surgery ⛔ Act as competitive agonist on nicotinic receptors on neuromuscular endplate ♣️Dosage♣️ ▶️ Intubation dose: 0.6 mg/kg IV ▶️ Rapid sequence induction: 1.2 mg/kg IV 🔴Pharmacology🔴 🔰 Its an intermediate acting MR 🔰 Onset (0.6mg/kg): 3 minutes, (1.2mg/kg): less than 1 minute 🔰 Duration: 30-60 minutes 🔰 Protein binding: 30% 🔰 Elimination Half-life: 1.5-4 hrs 🔰 Metabolized by liver 🔰 Excretion: 70% unchanged hepatic by bile, and 30% by kidney through urine ⛔Side Effects⛔ 💠 Nausea and vomiting 💠 Pain or discomfort upon injection 💠 Sleepness or lightheadedness 💠 Mild itching or skin rash 💠 Rarely cause hyper- or hypotension 💠 Hypersensitivity and anaphylaxis	233
10	✨Suxamethonium Chloride✨ ⛔ It is a depolarizing mr used for muscle relaxation during intubation, mechanical ventilation and surgical procedures ⛔ Suxamethonium is an agonist acts on nicotinic receptors and block the action of acetyl-choline ♣️Dosage♣️ ▶️ For endotracheal intubation: 1-2 mg/kg IV, and 3-4 mg/kg IM ▶️ For treatment of laryngospasm: 0.5 mg/kg 🔴Pharmacology🔴 🔰 Its a short acting MR 🔰 Onset of action: 30-60 seconds 🔰 Duration of action: less than 10 minutes 🔰Metabolism: by the action of Pseudocholinestrase enzyme 🔰 Excreted by kidney ⛔Side Effects⛔ 💠 Jaw rigidity 💠 Hypotension and bradycardia 💠 Increase intra-cranial pressure 💠 Increase intra-ocular pressure 💠 Muscle fasciculations which may cause post-operative pain 💠 Hypersensitivity and anaphylaxis	253
11	✨Muscle Relaxants✨ ⛔ There is 2 types of MR ⛔ Depolarizing MR (Suxcamethonium Chloride) ⛔ Non- Depolarizing MR (e.g. Rocuronium, Atracurium) ⛔ Used to make the patient " can not move" during surgery ⛔ MR DOES NOT INDUCE ANESTHESIA ⛔MR DOES NOT HAVE ANELGESIA	248
12	✨Sodium Thiopenone✨ ⛔ Ultra-short acting intravenous anesthetic barbiturates ⛔ Used to induce anesthesia and treatment of status epilepticus ♣️Dosage♣️ ▶️ Adults: 3-5 mg/kg ▶️ Children: 5-6 mg/kg 🔴Pharmacology🔴 🔰 Rapid onset about 30 seconds 🔰 Highly protein binding 🔰 Half-life 3-8 hours 🔰 Metabolized in liver and excreted by kidney 💠Systemic Effects💠 💢CNS💢 🔸 Decrease cerebral blood flow 🔸 Decrease cerebral metabolic rate 🔸 Decrease cerebral blood volume 🔸 Decrease ICP 💢CVS💢 🔸 Decrease myocaedial contractility 🔸 Peripheral vasodilation 🔸 Decrease arterial blood pressure (profound hypotension) 🔸 Decrease heart rate 🔸 Reflex tachycardia often occurs 💢Respiratory system💢 🔸 Decrease ventilation 🔸 Apnea often proceeded by few deep breaths 🔸 Increase bronchial muscle tone (bronchospasm) 🔸 Laryngeal spasm 💢Uterus and placenta💢 🔸 Readily cross placenta 💢Eye💢 🔸 Decrease intra-ocular pressure 🔸 Abolish corneal, conjunctival, eyelash and eyeball reflexes 💢Hepatorenal system💢 🔸Transient impaired functions ⛔Side Effects⛔ 🔰 Respiratory depression 🔰 Hypotension 🔰 Pain during intra-arterial injuction 🔰 Tissue necrosis 🔰 Laryngeal and bronchospasm 🔰 Allergic reactionS 🔰 Thrombophlebitis 💠Contraindications💠 🔸 Airway obstruction 🔸 Porphyria 🔸 Hypersensitivity	297
13	✨Ketamine✨ ⛔ An intravenous anesthetic induction agent ⛔ Can be given iv, im, orally, and nasally ⛔ Used to induce anesthesia, sedation and analgesia ♣️Dosage♣️ ▶️ Induction dose: 1-2 mg/kg ▶️ Analgesic dose: 0.5-1 mg/kg 🔴Pharmacology🔴 🔰 It is water and lipid soluble 🔰 Induce anesthesia about 30-60 sec (rapid onset) 🔰 Duration: 10-15 min 🔰 Acts as antagonist on NMDA receptors 🔰 Low protein binding 🔰 Metabolized in liver and excreted by kidney 🔰 Elimination Half-life about 3 hrs 💠Systemic effect💠 💢CNS💢 🔸 Increase cerebral blood flow 🔸 Increase cerebral metabolic rate 🔸 Increase cerebral blood volume 🔸 Increase ICP 💢CVS💢 🔸 Increase arterial blood pressure 🔸 Increase heart rate 🔸 Increase cardiac output 🔸 Increase myocardial oxygen consumption 💢Respiratory system💢 🔸 May cause transient apnea but ventilation is well maintained 🔸 Maintain pharyngeal and laryngeal reflexes 🔸 Bronchodilation 💢GIT💢 🔸 Increase salivation 🔸 May cause nausea and vomiting 💢Uterus and placenta💢 🔸 Cross placenta, but not produce significant fetal effects 💢Eye💢 🔸 Increase intra-ocular pressure 🔸Eye movement is maintained ⛔Side effects⛔ 🔰 Delirim, nightmares and hallucinations 🔰 Hypertension and tachycardia 🔰 Salivation 🔰 Increased ICP and IOP 🔰 Double vision and blurred vision 🔰 Allerguc reactions 💠Contraindication💠 🔸 Hypertension 🔸 Increased ICP 🔸 Increased IOP 🔸 Patient with depression diseases 🔸 Hypersensitivity	370
14	✨Propofol✨ ⛔An intravenous induction agent ⛔Used to induce and maintain general anesthesia, sedation and anti-epileptic agent ♣️Dosage♣️ ▶️ Children: 3-4 mg/kg ▶️ Adults: 2-3 mg/g ▶️ Infusion: 6-10 mg/kg/hr 🔴Pharmacology🔴 🔰 Acts on GABA receptors 🔰 Rapid onset: 20-40 second 🔰 Extremely lipid soluble 🔰 Effective Half-life: 30-60 min (يعني المدة الفعالة مالته قبل لا ينتهي مفعوله) 🔰 Elimination Half-life: 3-5 hr 🔰 Protein binding: 97-99% 🔰 Metabolized in liver, excreted through urine and feces 💠Systemic effects💠 💢CNS💢 🔸 Decrease cerebral blood flow 🔸 Decrease cerebral metabolic rate 🔸 Decrease cerebral blood volume 🔸 Decrease ICP 💢CVS💢 🔸 Direct myocardial depression 🔸 Arterial vasodilation and hypotension 🔸 Bradycardia 🔸 Decrease cardiac output 💢Respiratory💢 🔸 Decrease tidal volume 🔸 Decrease respiratory rate 🔸 Apnea 🔸 Attenuate pressor response to laryngoscopy and endotracheal intubation 💢GIT and urinary system💢 🔸 Decrease hepatic and renal blood flow 🔸 Prevent and treat nausea 💢Uterus and placenta💢 🔸 Propofol cross placenta and excreted by breast milk ⛔Side effects⛔ 🔰 Cardiovascular depression (hypotension) 🔰 Respiratory depression and apnea 🔰 Rash and itching (allergic reaction) 💠Contraindication💠 🔸 Hypotensive patient 🔸 Absolute airway obstruction 🔸 Infusion for children	384
15	Sodium thiopentone, which is FALSE	412
16	All of the following are adverse effect of thiopentone, EXCEPT	409
17	All is TRUE about systemic effect of thiopentone EXCEPT	386
18	Which is TRUE about cardiovascular effect of thiopenton	424
19	Systemic effect of sodium thiopenta on CNSl include all of the following except:	418
20	كل سؤال حطيتلكم بيه شرح بسيط، يلخص موضوع الكيتامين حتى تفيدكم هاي المعلومات بالتطبيق	436

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