Many questions from past papers have asked the canddiates to compare and contrast various sedative and analgesic agents. Specifically, the candidates have been expected to have indepth familiarity with propofol, dexmedetomidine, ketamine, morphine, tramadol, and celecoxib.
Examples of such questions have included the following:
- Question 17 from the first paper of 2008 (propofol vs. dexmedetomidine)
- Question 11 from the second paper of 2004 (ketamine vs. morphine vs. dexmedetomidine)
- Question 7 from the first paper of 2003 (anaesthetics used to control raised intracranial pressure)
- Question 3 from the second paper of 2001 (tramadol, celecoxib and ketamine)
The discussion section of each question offers a tabulated answer. In order to simplify revision, these tables are reproduced below with minimal alteration.
Feature | Properties |
Class |
|
Chemical properties |
|
Pharmacokinetics |
|
Receptor activity |
|
Mechanism of action |
|
Indications |
|
Advantages in head injury |
|
Disadvantages in head injury |
|
Adverse effects |
|
Feature | Properties |
Class |
|
Pharmacokinetics |
|
Receptor activity |
|
Mechanism of action |
|
Indications |
|
Advantages in head injury |
|
Disadvantages in head injury |
|
Adverse effects |
|
Feature | Properties |
Class |
|
Pharmacokinetics |
|
Receptor activity |
|
Mechanism of action |
|
Indications |
|
Advantages in head injury | |
Disadvantages in head injury |
|
Benefits in analgesia |
|
Adverse effects |
|
Feature | Properties |
Class |
|
Pharmacokinetics |
|
Receptor activity |
|
Mechanism of action |
|
Indications |
|
Advantages in head injury |
|
Disadvantages in head injury |
|
Benefits in analgesia |
|
Adverse effects |
|
Feature | Properties |
Class |
|
Pharmacokinetics |
|
Receptor activity |
|
Mechanism of action |
|
Benefits in analgesia |
|
Adverse effects |
|
Feature | Properties |
Class |
|
Pharmacokinetics |
|
Receptor activity |
|
Mechanism of action |
|
Indications |
|
Advantages in head injury |
|
Disadvantages in head injury |
|
Adverse effects |
|
A comparison of analgesics
Question 3 from the second paper of 2001 put these drugs specifically in the context of procedural sedation, "to aid the dressing of severe burns".
Features |
Tramadol |
Celecoxib |
Ketamine |
Class/mechanism |
Partial opioid receptor agonist; |
NSAID (selctive for COX-2) |
Anaesthetic; |
Advantages |
Synergistic with other analgesics Less respiratory depression than with other opiates |
Low toxicity |
Dissociative sedation |
Disadvantages |
Weak opioid effect |
May cause renal impairment |
Confusion, delirium |
References
Arain, Shahbaz R., and Thomas J. Ebert. "The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation." Anesthesia & Analgesia 95.2 (2002): 461-466.
Venn, R. M., and R. M. Grounds. "Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions†."British journal of anaesthesia 87.5 (2001): 684-690.
Jakob, Stephan M., et al. "Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials." JAMA307.11 (2012): 1151-1160.
Zor, Fatih, et al. "Pain relief during dressing changes of major adult burns: ideal analgesic combination with ketamine." Burns 36.4 (2010): 501-505.
Norman, Aidan T., and Keith C. Judkins. "Pain in the patient with burns." Continuing Education in Anaesthesia, Critical Care & Pain 4.2 (2004): 57-61.
Power, Camillus Kevin. "Burns Injury Pain Management-the evidence or not!."Official publication of the National Academy of Burns-India (2009).