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NEUROLEPTICS

A neuroleptic of buterphenons group — droperidol (dehydrobenzperidol) has a wide application in anesthesiology.

It is manufactured in bottles or ampules by 10 ml of 0.25% solution. Being the antagonist of dophamine receptors, it acts on CNS, namely, on a trigger zone of medulla oblongata and caudate nucleus, as well as on the mechanism of nerve impulse transfer by means of serotonin, norepinephrine and GABA.As a result, it exerts sedative and antiemetic effects. Besides, it is a

peripheric y-adrenoblocker causing vasodilating and antiarrhythmic effect. It contributes to the release of catecholamines from medullar layer of adrenals. Droperidol does not produce, in usual doses independently, analgesia, amnesia and loss of consciousness. Only in combination with analgetics it ensures neuroleptanalgesia (analgesia, nonmotility and partial amnesia), but only with the addition of hypnotics (for example, nitrous oxide) a loss of consciousness is achieved — one of the conditions of general analgesia that, in this case, may be called as neuroleptanesthesia.

In intravenous or intramuscular injection (premedication) the action begins slowly because of the high-molecular structure and binding with proteins and continues for a long time on account of the stable bond with receptors.

It is intensively metabolized in the liver products of metabolism are excreted by the kidneys.

It is included in the course of premedication — intramuscularly 0.04-0.07 mg/kg or intravenously 0.020.07 mg/kg in combination with opioids.

Maintenance of anesthesia is implemented intravenously with 0.07-0.15 mg/kg in combination with fentanyl and hypnotics repeatedly, if there are signs of weakening of droperidol effect (before all, a rise of AP).

It is used intravenously in the dose of 0.05 mg/kg to treat hypertensive crisis, motor and emotional anxiety, persistent nausea and vomiting.

Contraindications — hypovolemia, intake of hypotensives, pheo-chromocytoma, extrapyramidal disorders, disturbance of intracardiac conduction.

It eliminates the action of clonidine, increasing arterial hypertension. It weakens levodopa effect provoking parkinsonism, as well as a hypertensive effect of ketamine and increases the effect of hypotensive agents.

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