Anesthetic Agents of Choice & Contraindications

Anesthetic Agents of Choice & Contraindications

Table of Contents(toc)

Anesthetic Agents of Choice


  • Ketamine: Preferred in bronchial asthma due to its potent bronchodilator effect.

  • Ketamine Contraindications: Avoid in hypertension, ischemic heart disease (IHD), increased intracranial pressure (ICT), intraocular pressure (IOP), and psychiatric disorders (e.g., schizophrenia).

  • Isoflurane: Ideal for neuro and cardiac anesthesia due to its ability to maintain cerebral perfusion and hemodynamic stability.

  • Isoflurane Contraindications: Avoid in hypotension, coronary steal syndrome (in CAD), and patients prone to bronchospasm.

  • Isoflurane > Desflurane for Hepatic Anesthesia: Isoflurane is safer than desflurane in liver disease due to lower metabolism-related toxicity.

  • Desflurane Contraindications: Avoid in severe liver dysfunction and patients with asthma (due to airway irritation).

  • Sevoflurane: Best for pediatric anesthesia due to its non-irritant, smooth induction, and rapid onset.

  • Sevoflurane Contraindications: Avoid in renal dysfunction (due to fluoride ion nephrotoxicity) and malignant hyperthermia-prone patients.

  • Desflurane for Daycare Surgery: Preferred due to low blood-gas solubility, fast onset, and quick emergence.

  • Desflurane Contraindications: Avoid for induction (due to airway irritation), patients with severe cardiac disease (tachycardia risk).

  • Propofol: IV Agent of Choice for Daycare Surgery: Due to rapid onset, short duration, and antiemetic effects.

  • Propofol Contraindications: Avoid in hemodynamically unstable patients, egg/soy allergy, and risk of propofol infusion syndrome (PRIS) in prolonged use.

  • Etomidate: Hemodynamically Stable Induction: Preferred in cardiovascular instability due to minimal effects on BP.

  • Etomidate Contraindications: Avoid in adrenal insufficiency (as it suppresses cortisol synthesis).

  • Thiopental: Neuroprotective Anesthetic: Used in neurosurgery for its cerebral protection in head trauma and stroke.

  • Thiopental Contraindications: Avoid in hypotension, porphyria, and obstructive airway disease.

  • Lidocaine: Local Anesthetic of Choice: Used in minor surgeries, epidurals, and nerve blocks.

  • Lidocaine Contraindications: Avoid in methemoglobinemia and severe hepatic disease.

  • Bupivacaine: Long-acting Local Anesthetic: Preferred for spinal and epidural anesthesia.

  • Bupivacaine Contraindications: Avoid in cardiac disease (risk of cardiotoxicity at high doses).

  • Spinal/Epidural Anesthesia Contraindications: Avoid in coagulopathy, severe hypovolemia, and sepsis.

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