CLINICAL

ANESTHESIA
BCSE level
 Classes of drugs
1. OPIOIDS

2. PHENOTHIAZINES

3. BENZODIAPZEPINES

4. DISSOCIATIVE ANESTHESIA

5. BARBITURATES

6. α & β ADRENERGICS

7. α & β BLOCKERS

8. OTHERS
 Classes of drugs
1. OPIOIDS Full opioid agonist: Partial opioid Synthetic:
(mu, kappa, delta) agonist: Tramadol
2. PHENOTHIAZINES Morphine Buprenorphene
Oxymorphine Butorphanol
3. BENZODIAZEPINES Hydromorphine
Fentanyl
4. DISSOCIATIVE ANESTHESIA Methadone
Hydrocodone
5. BARBITURATES Codeine
Oxycodone
6. α & β ADRENERGICS
ANTIDOTE:
7. α & β BLOCKERS Naloxone
8. OTHERS Naltrexone
 Classes of drugs
1. OPIOIDS

2. PHENOTHIAZINES
Sedative &
tranquilizers
3. BENZODIAZEPINES

4. DISSOCIATIVE ANESTHESIA
Acepromazine
5. BARBITURATES
Chlorpromazine
6. α & β ADRENERGICS

7. α & β BLOCKERS

8. OTHERS
 Classes of drugs
1. OPIOIDS

2. PHENOTHIAZINES
Diazepam
3. BENZODIAZEPINES Midazolam
4. DISSOCIATIVE ANESTHESIA
Alprazolam

5. BARBITURATES

6. α & β ADRENERGICS

7. α & β BLOCKERS
ANTIDOTE:
8. OTHERS
Flumazenil
 Classes of drugs
1. OPIOIDS

2. PHENOTHIAZINES

3. BENZODIAZEPINES

4. DISSOCIATIVE ANESTHESIA
Ketamine
Tiletamine
5. BARBITURATES

6. α & β ADRENERGICS

7. α & β BLOCKERS

8. OTHERS
 Classes of drugs
1. OPIOIDS

2. PHENOTHIAZINES

3. BENZODIAZEPINES

4. DISSOCIATIVE ANESTHESIA
Short Acting: Intermediate Acting Long Acting
5. BARBITURATES Thiopental Pentobarbital Phenobarbital
Methohexital
6. α & β ADRENERGICS

7. α & β BLOCKERS
ANTIDOTE:
8. OTHERS
Nikethamide
 Classes of drugs
1. OPIOIDS

2. PHENOTHIAZINES

3. BENZODIAZEPINES

4. DISSOCIATIVE ANESTHESIA

5. BARBITURATES
Propofol
6. α & β ADRENERGICS Etomidate
Alfoxalone
7. α & β BLOCKERS
Chloral hydrate
8. OTHERS MgSO4
Chloralose
 α & β ADRENERGICS
Alpha Beta

α1 α2 β1 β2 β3 Non selective β

Non selective αβ
 α & β ADRENERGICS
Alpha Beta

α1 α2 β1 β2 β3 Non selective β

Phenylephrine Xylazine
Detomidine
Medetomedine
Dexmedetomidine Non selective αβ
 α & β ADRENERGICS
Alpha Beta

α1 α2 β1 β2 β3 Non selective β

Dobutamine Clenbuterol Isoproterenol

Phenylephrine Xylazine Albuterol/ (isoprenaline)
Detomidine salbutamol
Medetomedine
Dexmedetomidine Non selective αβ Terbutaline
 α & β ADRENERGICS
Alpha Beta

α1 α2 β1 β2 β3 Non selective β

Dobutamine Clenbuterol Isoproterenol

Phenylephrine Xylazine Albuterol/ (isoprenaline)
Detomidine salbutamol
Medetomedine
Dexmedetomidine Non selective αβ Terbutaline

Catecholamines
Epinephrine α1 β1 β2 α1

Norepinephrine α1 β1
β2
Dopamine D1 D2 ↑Dose: β1 β2 α2
Dobutamine β1 ↑Dose: β2 α1
 α & β ADRENERGICS
Alpha Beta

α1 α2 β1 β2 β3 Non selective β
Adipose
Dobutamine Clenbuterol tissue Isoproterenol
Phenylephrine Xylazine Albuterol/ (isoprenaline)
Detomidine salbutamol
Medetomedine
Dexmedetomidine Non selective αβ Heart, kidneys Terbutaline
↑HR, SV, CO
Arteries
Arteries (all organs) Veins Catecholamines Vasodilation
Vasoconstriction Venodilation
↑BF, TPR ↓HR, CO, RR Epinephrine α1 β1 β2 α1
Hypotension Norepinephrine α1 β1
β2
Dopamine D1 D2 ↑Dose: β1 β2 α2
Dobutamine β1 ↑Dose: β2 α1
 α & β ADRENERGICS
Alpha Beta

α1 α2 β1 β2 β3 Non selective β
Adipose
Dobutamine Clenbuterol tissue Isoproterenol
Phenylephrine Xylazine Albuterol/ (isoprenaline)
Detomidine salbutamol
Positive Medetomedine
Ionotrope Dexmedetomidine Non selective αβ Heart, kidneys Terbutaline
↑HR, SV, CO
Arteries
Arteries (all organs) Veins Catecholamines Vasodilation
Vasoconstriction Venodilation
↑BF, TPR ↓HR, CO, RR PI, VC Epinephrine α1 β1 β2 α1
Hypotension VC Norepinephrine α1 β1 β2
PI Dopamine D1 D2 ↑Dose: β1 β2 α2

PI Dobutamine β1 ↑Dose: β2 α1
 α & β BLOCKERS

Alpha blockers Beta blockers

Non selective β
α1 α2 Non-selective
α blocker
β1 β2 blockers

Prazosin Youhimbine Phentolamine Atenolol No clinical use Pindolol

Atipemazole Phenoxybenzomine Metoprolol Sotalol
Tolazoline Propranolol
 CHOLINERGIC DRUG CLASSES

Parasympathomimetic/
Cholinergic/ Parasympatholytics
Cholinomimetics
 CHOLINERGIC DRUG CLASSES

Parasympathomimetic/
Cholinergic/ Parasympatholytics
Cholinomimetics

Direct acting Indirect acting/ Parasympathomimetic Ganglionic

Cholinesterase inhibitors/ antagonist/ blocking drugs/
Anticholinesterrase antimuscarinic Nicotine
antagonist
 CHOLINERGIC DRUG CLASSES

Parasympathomimetic/
Cholinergic/ Parasympatholytics
Cholinomimetics

Direct acting Indirect acting/ Parasympathomimetic Ganglionic

Cholinesterase inhibitors/ antagonist/ blocking drugs/
Anticholinesterrase antimuscarinic Nicotine
antagonist

Acetylcholine [Link] (Reversible)

Methacholine Physostigmine
Carbachol Neostigmine
Bethanecol Edrophonium
Pilocarpine [Link]
compounds (irreversible)
 CHOLINERGIC DRUG CLASSES

Parasympathomimetic/
Cholinergic/ Parasympatholytics
Cholinomimetics

Direct acting Indirect acting/ Parasympathomimetic Ganglionic

Cholinesterase inhibitors/ antagonist/ blocking drugs/
Anticholinesterrase antimuscarinic Nicotine
antagonist

Acetylcholine [Link] (Reversible) Atropine Hexamethonium

Methacholine Physostigmine Glycopyrolate Trimethaphan
Carbachol Neostigmine Scopolamine
Bethanecol Edrophonium
Pilocarpine [Link]
compounds (irreversible)
ICP: Pain on injection:
↑: Barbiturates, Benzodiazepine, Alfaxolone, Propofol Etomidate
↓: ketamine, opioids Ketamine

IOP: Perivascular tissue necrosis:

↑: Ketamine Etomidate
Barbiturates
Non-analgesics:
Benzodiazepines (Diazepam)
Barbiturates
Etomidate
Propofol
Phenothiazines
ANESTHESIA
TERMS
 ANESTHESIA TERMS
Anesthesia Complete unconscious + no response to painful stimuli
Sedation  nearly unconscious + purposeful response to painful stimuli
Tranquilization behavioral change where anxiety is relieved. Patient becomes relaxed
but aware of surroundings
 drugs that cause it are anxiolytics, antianxiety, tranquilizers
Narcosis  deep sleep from which patient cannot be easily aroused
Hypnosis artificially induced sleep or trans resembling sleep resulting from moderate
CNS depression from which patient is readily aroused
Balance anesthesia  anesthesia achieved by multiple drugs (unconsciousness,
analgesia, no reflex)
Dissociative anesthesia drugs dissociate thalamacocortic & limbic system. It is
characterized by a cataleptoid state where eyes remain open, swallowing reflexes are
intact & skeletal muscles are contracted.
 KETAMINE
Dissociative anesthesia
 KETAMINE
Dissociative anesthesia  thalamaco-cortical Unknown MOA ------ NMDA antagonist
system dissociates  change in awareness Cataleptic state of CNS  Patient neither sleeps nor responses to stimuli

Eyes of animal stay open  dry  Muscle rigidity & tremor not used for orthopedic surgery or use in
administer tear drops or NS to moisten them combinations

Provides good superficial analgesia but poor visceral analgesia Anticonvulsant or

It is used with other agents like alpha 2 agonists, opioids, benzodiazepines to provide analgesia neuroprotective
MLK  Morphine, lidocaine & ketamine property

Crosses placenta  enters fetal circ  neurologic reflexes in C section born puppies
Ketamine & tiletamine are used to anesthetize snakes for non-painful procedures (skin biopsies)

↑cerebral BF  ↑ICP  Rx Benzodiazepines or thiopental (barbiturate) Violent Recovery Abnormal behavior

 Contraindicated in patients with head injuries leading to emergence delirium during
↑sympathetic tone  ↑IOP & CO  contraindicated in cats with hypertrophic recovery , ataxia, touch sensitive,
cardiomyopathy ↑motor activity

 apnea  prolong inspiration & very short expiration

 Bronchial SM relaxant  bronchodilation  ↓airway resistance  good choice for patient with asthma & COPD
 Pharyngeal & laryngeal reflexes intact
 ↑salivation & respiratory tract secretions  aspiration risk Rx Endotracheal Tube or atropine
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Barbiturates
 Barbiturates
Injectable anesthesia Anticonvulsant No analgesia Nikethamide antidote

Perivascular injection  tissue necrosis MOA  GABA Receptor activation  CNS depression unconcious

CNS: depression, ↓ICP, ↓cerebral BF CVS: ↑HR, vasodilation of skeletal & cutaneous BV

Respiratory: Transient periods of apnea, bronchoconstriction  to avoid respiratory depression inject very slowly

1 Euthanasia  Pentobarbital Dogs & cats

2 Seizure/anticonvulsants phenobarbital 1st line of choice as anticonvulsant
3 Anesthesia all other barbiturates (thiopental) Hepatotoxic  contraindicated in liver disease patient

Pentobarbital  euthanasia  MOA: extreme CNS depression when overdose

This rapidly & painlessly depress all vital functions of CNS  loss of consciousness in seconds & death w/I mins

(if no IV line) then Intraperitoneal injection of pentobarbital + lidocaine = appropriate method of euthanasia
Intra-organ euthanasia  intra-cardiac, intrahepatic etc.
Propofol
 PROPOFOL
Non barbiturate MOA GABA receptors Minimum to no analgesic

Oil in water emulsion: 1%propofol, 10%soybean oil, 2.25%glycerol, 1.2%purified egg phosphatide

No preservative in formulations  support bacterial & fungal growth

Once vial is open  discard after 6 hours

Not used in cats as it is metabolized by sulfide & glucuronide metabolism

CNS depression, ↓ICP CVS: ↓BP, ↓HR, ↓cardiac contractility, myocardial depression

Respiratory depression, apnea, transient cyanosis

Muscle relaxation Best suited for procedures where good muscle relaxation is needed like
pelvic radiographs

Induction  nystagmus, paddling, opisthotonas in dogs for bone biopsy are normal side effects
Horses: excitement on injection
OPIOIDS
 OPIOIDS
Mu, kappa, delta Antitussive, sedative, analgesia Transdermal patch for analgesia
Buprenorphine
Tolerance develops overtime (receptor desensitization) fentanyl
Withdrawal signs  nausea, vomit, aggression, muscle twitching, anorexia, muscle weakness

Emetic  morphine
Antiemetic  Fentanyl, butorphanol, methadone

Adverse reaction: Respiratory depression, ↓HR, hypotension, urinary retention

Rapid IV histamine release  anaphylactic response  ↑HR, hypotension, bronchospasm

Dysphoria (vocalization, agitation & excitement are common side effects)

Rx tranquilizer/sedative (acepromazine or dexmedetomidine)
If persistant & significant dysphoria opioid antagonist naltrexone

GIT effects  colic horses Pupil diameter:

Causes post op constipation Miosis  dogs, Rabbits
Inhibitory effects  ↓motility & secretion Mydriasis cats, Horses, Ruminants
Morphine colonic motility inhibited
Butorphanol  jejunal motility inhibited
Butorphanol
Synthetic opioid with mixed agonist/antagonist property
Useful in horses
Kappa agonist  analgesia  Analgesic effects >2 hrs. in dogs
with colic as its
Mu antagonist  cough suppressant  used to reverse morphine or pure mu
binding to kappa
agonist but it is less potent mu
for pain relief
antagonist than naloxone

Provides mild sedation in young but effects are higher in older animals
Use in combination with tranquilizers/sedatives (acepromazine/a2 agonist) to improve sedative effects
In healthy horse head tremors initially occur but dissipate w/I few mins

Fentanyl
More potent than morphine
Given as transdermal patch or CRI  ↑abs with ↑body temp & vice versa
Lipophilic so absorbed & eliminated quickly  not useful for pain control via single dose IM/IV
Produces good analgesia
Less likely to cause nausea & vomiting than morphine & other mu opioids
Adverse effects: respiratory depression & dysphoria
Hydromorphine
 Dysphoria is common side effect Nalaxone
 Restlessness, agitation, vocalization, lack of response to
Effective at all receptors (mu,
surrounding
kappa, delta)
 Rx for dysphoria tranquilizer/sedative  acepromazine or
Greatest activity at mu receptor
dexmedetomidine
 Hyperthermia in cats

Buprenorphine
 preferred narcotic for pain control in cat only as cats absorb from oral mucous
membrane
 used IM or IV for up-to 8hr pain control
 Most popular & relied analgesia in cats
 Being partial my agonist, doesnot causes most of AE of pure mu agonists like nausea,
vomit, dysphoria
 Duration long, 6 hrs or more
 Onset  long, 30mins to hour in cats & dogs
 Difficult to reverse as tightly bound to mur eceptor
 Transmucosally 100% absorbtion as pH f feline mouth (8-9) favours it
acepromazine
 ACEPROMAZINE
Phenothiazine tranquilizer Hypotension Sedation Penis protrusion Antiemetic Negligible analgesic

Exact MOA not known but it causes sedation via antagonism of central dopamine receptors.

Blockade of peripheral a1 receptors caused vasodilation & hypotension

Penis protrusion in large animals especially horses

Causes relaxation of SM & engorgement of corpus cavernous with blood, leading to withdraw the penis
into sheath or paraphimosis
Often part of sedative mix for male horses when passing urinary catheter, performing penile Sx

Antiemetic in motion sickness in dogs, pre-anesthetic with atropine

Least cardiac & respiratory depression

Splenic dilation  decreased Hct & Hb in lab reports

Avoid using in animals with OP toxicity as it exacerbates the toxic effects

Used reduced dose in geriatric patients

ATROPINE
 ATROPINE
Indications Contraindications
 Vagally induced bradycardia  Tachyarrhythmia
 Sinoatrial arrest  Alpha 2 induced bradycardia
 CPR  Ileus/ GI obstruction
 Rx of OP toxicity, carbamate toxicity, blue  Urinary tract obstruction
green algae, muscarinic mushrooms  Narrow angle glaucoma

 Glycopyrolate does not crosses BBB so few CNS effects than atropine

Xerostomia, reduced tearing & bronchial secretions ---- Use with ketamine
Decreases GIT motility
Causes ileus in horses so use in caution to dry airway secretions & anesthesia
surgically

Horse: atropine used to treat bronchoconstriction as it causes bronchodilation

Also used as pre-anesthetic drug with ketamine

Mydriasis/ pupil dilation for 3 days  Cats go blind

Used in CPR to stimulate HR

Inhibit vagal effects on HR & cause ↑HR & GIT, respiratory & salivary secretion

Atropine ↑HR
 Vagally induced bradycardia YES
 Alpha 2 induced bradycardia XXX

Contraindicated for reflex bradycardia seen with xylazine or dexmedetomidine in cats & dogs

Atropine blocks parasympathetic tone in heart which causes ↑HR

Alpha 2 agonists (dexmedetomidine/ xylazine) cause vasoconstriction & ↑BP. HR slows in
response to high BP & increased systemic vascular resistance
This is reflex bradycardia or baroreceptor response as CVS strives to keep BP w/I normal
range.
Acetylcholine
 Acetylcholine Effects
1. Eye  Pupil constriction, near vision better, ↑lacrimal gland
2. Respiration Bronchial SM contracts  lumen constricts
Bronchial secretion ↑
3. CVS M2R  ↓HR, SV, CO
4. GIT  salivary gland secretion ↑
stomach cells ↑ secretion  ↑acids  ↑ulcers
sphincters open  relax (inhibitory)
Peristalsis ↑
5. Urinary  ↑urine production  Detrusor muscle  contracts
Sphincters relax
6. Reproduction  Male: penile erection  PNS
ejection  SNS
Female: vaginal secretions

SIDE EFFECTS: DUMBELSS  defecation, Urination, Muscle contraction, Bradycardia, Erection,

Lacrimation, sweating, salivation
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Complex anesthetic machines
Anesthesia
machine
Gaseous anesthesia equipment
Image courtesy: veterinary anesthesia by lumb & jones chapter 3 (kath klassen)
1 Oxygen supply cylinders/ central line

Image courtesy: veterinary anesthesia by lumb & jones chapter 3 (kath klassen)
1 Oxygen supply cylinders/ central line
2 anesthetic machine

Image courtesy: veterinary anesthesia by lumb & jones chapter 3 (kath klassen)
1 Oxygen supply cylinders/ central line
2 anesthetic machine
3 breathing circuit

Image courtesy: veterinary anesthesia by lumb & jones chapter 3 (kath klassen)
 COMPONENTS OF MACHINE:

Oxygen Cylinders  Source of Oxygen (white color)

 COMPONENTS OF MACHINE:
Gauge  Pressure gauge  measures pressure in gas cylinders,
anesthetic machines, breathing systems
 COMPONENTS OF MACHINE:
Hanger Yoke  O2 cylinder attached to anesthesia machine via yoke
as it causes gas tight seal & ensures unidirectional flow of gases to
machine
 COMPONENTS OF MACHINE:

Regulator  pressure reducing valve used to bring high pressures of gas cylinders down to a
more reasonable & safe working pressure
 Pressure of gas varies at different locations

High pressure areas  Accepts gas at cylinder pressures & reduces & regulates the pressure
Includes gas cylinders, hanger yokes, high pressure hoses, regulators
2200psi

Intermediate pressure areas  accepts gases from central pipeline or from regulators on anesthesia machine &
conducts them to flush valve & flowmeter
Includes pipeline inlets, flowmeters, oxygen flush apparatus
40-55psi

Low pressure areas consist of conduits & components btw flowmeter & common gas outlet
Includes vaporizers, piping from flowmeters to vaporizer, conduit from vaporizer to
common gas outlet, breathing system
Pressure is close to ambient pressure (here pressure should never exceed 30cmH2O as
these pressures are transmitted directly to patients lungs )
 COMPONENTS OF MACHINE:
Flowmeter  controls rate of gas delivery to low pressure area of anesthesia machine &
determine fresh gas flow to anesthesia.
Separate flow meter for each type of gas used
Gas enters from bottom & exits from top
 COMPONENTS OF MACHINE:
Vaporizer  changes liquid anesthesia into vapor & measures the amount of vapor
leaving vaporizer
Temperature, pressure & flowrate alters vaporizer output
 COMPONENTS OF MACHINE:
Flow rate Rate at which gas flows controlled by flow meter
Changes in flowrate through vaporizer  changes in output
Example: high flowrate  incomplete saturation of gas moving from vaporizer chamber 
↓Output
Clinically useful Flow rate = 500-2000mL/min
 COMPONENTS OF MACHINE:
Oxygen flush valve  not present in all machines, if present it is designed to rapidly
deliver large volume of pure oxygen/ non-anesthetic gas to patient breathing circuit in
emergency situation.
It by passes flowmeter & vaporizer
Patient starts to wake up
 COMPONENTS OF MACHINE:
Common gas outlet  Connects anesthetic machine to breathing circuit. Gas reaching CGO
has travelled from gas supply (cylinder or pipeline) through regulator, flowmeter, vaporizer. Gas
flowing from CGO delivers anesthesia & carrier gas to patient circuit at concentration &
flowrate determined by vaporizer setting & flowmeter flowrate.
 COMPONENTS OF MACHINE:
CO2 absorbent canister  chemicals that absorb exhaled CO2.
E.g.: soda lime, baralyme (barium lime) & Amsorb lime (Ca(OH)2) can be used
CO2 absorption principle involves a base (absorbent) that neutralizing acid (CO2). & end products are
water, Carbonate (CaCO2) & heat
 CO2 CANISTER

Fresh soda lime is white & can be crushed

Exhausted soda lime is off white & is hard
Color usually changes to purple or violet. Granules contain pH sensitive
dye so color itself is not important as color changes
When soda lime is exhausted & unable to absorb more CO2, end tidal CO2
(ETCO2) increases on capnography.
Color change of granules is not acceptable way of identifying exhaustion
Dispose wasted soda lime in trash
Soda lime life is dependent on flow rate. High flow rate depletes granules
more quickly than lower flow rate
Scavenging system  removes waste
anesthetic gases from breathing circuit to
either outside building or into charcoal canister
Change charcoal when it increases 50g weight
 COMPONENTS OF MACHINE:
Reservoir bag  referred as breathing or rebreathing bag. It is a collapsible gas container, which
permits manual ventilation
It also acts as a visual or tactile indicator of spontaneous breathing by changing its volume with
patients expiration & inspiration. It is recommended that rebreathing bag have volume
approximately 5-10x of the patients normal tidal volume (10-20ml/kg) or roughly equivalent to
patients minute volume
 COMPONENTS OF MACHINE:
Fresh gas inlet  site of gas delivery to circulating system from common gas outlet of
anesthesia machine.
Fresh gas inlet is normally found after CO2 absorbent & before inspiratory one way valve
 COMPONENTS OF MACHINE:
Inspiratory one way valve  during inspiration, one way valve opens, allows gases to
move from fresh gas inlet & reservoir bag to valve into inspiratory limb of breathing circuit.
During expiration it is closed, preventing exhaled gases entering inspiratory limb
 COMPONENTS OF MACHINE:
Expiratory one way valve  functions together with inspiratory one way valve, closing
upon inspiration & opening during expiration. It directs gas from expiratory limb via
expiratory valve to reservoir bag
 COMPONENTS OF MACHINE:
Pop-off valve  also called as adjustable pressure limiting valve (APL), overflow valve, pressure
relief valve.
APL is safety valve allowing excess gas to escape from patient circuit. If valve is functioning properly,
gas should escape if system pressure exceed 1-3cm H2O. Normally it should be left fully open at all
times unless PPV is used.
 COMPONENTS OF MACHINE:
Breathing circuit tubing  made up of a corrugated plastic or rubber inspiratory and expiratory
limbs. The corrugated tubing helps prevent kinking and allows for some expansion if the breathing
circuit is subjected to compression or traction. The two breathing limbs are connected via a Y‐piece
that connects to the endotracheal tube or facemask.
 Types of
Breathing
Systems
1 Oxygen supply cylinders/ central line
2 anesthetic machine
3 breathing circuit

Image courtesy: veterinary anesthesia by lumb & jones chapter 3 (kath klassen)
 Types of Breathing Systems

Purpose: deliver O2 to patient, deliver anesthetic gas to patient, remove CO2 from inhaled
breaths & provide a means of controlled ventilation.

1. Rebreathing circuit / Closed circuit

2. Bain system / Non rebreathing circuit
1. Partial rebreathing circuit / semi closed circuit
2. Non rebreathing circuit / minimal rebreathing circuit
Closed circuit / Rebreathing circuit
circle system using flow rates equal to or near the metabolic O2 consumption of patients, between 3-
14mL/Kg/min
Lowest flow
Rebreathing of exhaled gas, with modification that CO2 canister absorbs CO2
Partial rebreathing circuit
Circle system using flow rate greater than metabolic O2 consumption (eg 20mL/kg/min) but less than
required to prevent rebreathing. Since it is a very large range it is often divided into
low flow (20-50mL),
mid flow (50-100mL/Kg/min) &
high flow (100-200mL/Kg/min).

Non rebreathing circuit No mixing of inhaled & exhaled gases

Highest flowrate
Circle system using flowrate greater than 200mL/Kg/min (flow rate that would normally not be used in most
circumstances)
Such unusually high flowrate may result when circle system are used for maintenance of anesthesia in very
small patient (<5kg) with flow rate of 1000mL/min or greater.

In non rebreathing system, exhaled gas pass through another hose & may enter a reservoir bag, but do not
enter a CO2 absorber. The gas is then released into scavenger
Bain system
Rebreathing system
Gases used as inhalant anesthetics
1. Isoflurane
2. Desflurane
3. Sevoflurane
4. Halothane
5. methoxyflurane
properties
of Inhalant
anesthesia
Properties
1. MAC  amount of anesthesia necessary to prevent pain response to painful stimuli in 50% of patients.
2. Potency  concentration of drug needed to produce desired effect
3. Solubility  drugs ability to dissolve in body solvents (tissue & blood)

Potency ∞ solubility ∞ 1 ∞ 1 ∞ 1
% requirement of drug fast induction MAC
e.g. less soluble drug  ↑% requirement of drug  fast induction

MAC: Desflurane > Sevoflurane > isoflurane

Potency: Desflurane < Sevoflurane < Isoflurane
Solubility: Desflurane < Sevoflurane < Isoflurane
Induction: Desflurane > Sevoflurane > isoflurane
Recovery: Desflurane > Sevoflurane > isoflurane
ALPHA 2 AGONISTS
Xylazine
medetomidine,
dexmeditomidine
 XYLAZINE
Analgesia Sedation respiratory depression Profound cardiac effects

CVS: vasoconstriction, hypertension, bradycardia, ↓CO, cardiac arrthymias, 2nd degree AV block

Alpha 2 agonist  ↓HR is common so no response is needed

↓HR persists & rarely requires treatment
Eg in horse, xylazine causes ↓HR & second degree AV block & ↓RR but it needs no treatment
Never use anti muscarinic (atropine) to ↑HR
Dexmedetomedine contradicted in cardiac patients as ↓HR, second degree AV block occur  death

Use with opioids to ↑ duration of anesthesia (e.g. butorphanol + xylazine)

Antidotes:
Dexmedetomedine  atipemazole (use same volume of atipemazole as of dexmedetomidine to
reverse it)
Xylazine  youhimbine
Alpha 2 agonists inhibit release of norepinephrine at presynaptic alpha 2 receptors both centrally &
peripherally
Alpha 2 agonist also stimulate alpha 1 receptors at postsynaptic sites.

Potency of alpha 2 agonists from highest to lowest ratio of alpha 1 to alpha 2 receptor action
Medetomidine 1:1620
Romifidine 1:340
Detomidine 1:260
Xylazine 1:160

Cattle & ruminants most sensitive to xylazine sedative effects

Xylazine sensitivity : cattle > camel > swine
Cattle has 1/10th dose of horse
↓dose produces sedation w/o recumbency

Xylazine dose rates:

Bird (0.2kg-2kg) 10mg/kg
Dog (10-40kg) 1-2mg/kg
Horse (100kg-400kg) 0.1-1mg/kg
Ruminant 0.01-0.03mg/kg
 THANKS FOR WATCHING
Content making takes lot of effort so

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