In which of the following condition ketamine can be used:
Ans: a (Hypovolaemia) Ref: Ajay Yadav, 2nd ed, p. 78,139,141Ketamine stimulates sympathetic system causing:TachycardiaHypertensionIV anaesthetic of choice in shock ie good for hypovolaemic patientsIV anaesthetic of choice in asthmaticsCauses dissociative anaesthesia, i.e.. a state of profound analgesia, light sleep, increased muscle tone and emergence deliriumMarked analgesia is a prominent feature and more analgesic than propofol and thiopentanone causes increased muscle tone and myalgia.It is anaesthetic of choice in skin grafting.Dissociative anaesthesia is due to excitation of limbic system and inhibition of thalamus and neocortex.pH of 10% solution is 4IV doseIM doseInfusion rateOral dose- 1 -2 mg/kg of body weight- 6-10 mg/kg- 40 microgram /kg/mt- 6 mg/kgSide effects:Increase all pressures! intracranial, intraocular, blood pressure)Post operative myalgia and myoglobinuriaHallucination and diazepam is used for treatmentIncreased salivation use atropineDrug of choiceHepatic failureRenal failureAnaesthetic agentIsoflurane/ sevofluraneIsoflurane/ sevoflurane/desflurane/ halothaneMuscle relaxantAtracurium /cisatracuriumAtnicuiium/ cisatracurium/ fentanylOpiodFentanylFentanylContraindicationNoneMethoxyflurane/ gallaminc/ enfluraneAnaesthetic of choice in:Cardiac patientsDay care surgeryIntravenous- etomidateAnaesthesia- propofol + alfentanyl + isofluraneInhalation- isofluraneOpiod- alfentanyl > fentanylMR- vecuroniumShock patient- IV ketamineAsthmatic patientNeonates and childrenIntravenous- ketamineInhalation- sevofluraneInhalation- halothaneIntravenous- thiopentoneMR- pancuronium> propofol Neurosurgical operationsAneurysm surgery-Isoflurane + thiopentone / propofolEtomidateElectroconvulsive therapy-Total intravenous anaesthesia-MethohexitoneProporfol -falfentanyl / fentanylPatient susceptible to malignant hyperthermiaControlled hypotensionInduction- propofolIsoflurane Maintenance- nitrous oxide Local anaesthesia-- procainePhaeochromocytomaEnfluraneHaemorrhagic shock- cyclopropaneEpilepticsInduction - thiopentoneMaintainence - isofluraneSkin grafting- ketamine Muscle relaxant causing histamine release (MAST)MivacuriumAtracutiumSuccinylcholineD-Tubocurarine
Hypovolemia
Myocardial infarction
Hypertension
Head injury
General Anesthesia