4 IV Anesthetics Flashcards
Propofol resp effects
Shifts co2 response down and to right, inhib hypoxic vent drive
Risk factors for propofol infusion syndrome
> 4mg/kg/hr (>67mcg/kg/min), gtt >48 hrs, kids, sepsis, inadeq 02 deliv, cerebral injury
Presentation of propofol infusion syndrome
Metab acid, rhabdo, fatty liver, renal failure, HLD, lipemia early on, bradycardia
How fospropofol is diff
No burning, less microbial growth, slower onset, longer duration. Genital and anal burning
Ketamine clearance, excretion of what
Liver p450. Renal excretion of active metabolite
When ketamine is a myocardial depressant
Requires an intact sns to inc hr and bp. If depleted catecholamines (sepsis, sympathectomy) will be unmasked
Induction agent w smallest amt protein binding, %
Ketamine, 12%
Induction agents w largest amt protein binding, %
Prop and valium 98%
Induc agent % protein binding: versed, etomidate, precedex, ativan
94, 75, 94, 90
Etomidate cv and resp fx
Small dec in SVR/bp, mild resp dep (less than prop and barbs)
Induc agent that inc mortality in Addisonian crisis
Etomidate
Who to avoid etomidate in
Sepsis or acute adrenal failure
Thiobarbs v oxybarb and example
Thio= sulfur, inc potency, TPL. Oxy= 02, methohexital
Thiopental: ___ soluble, ph ____, dose, clearance
Water, 9 (alkaline), 2.5 adults 5 peds, liver p450
TPL: cv fx
Hypotension, reflex tachy, histamine release
TPL resp fx
Bronchoconstriction and co2 response curve shifted right
Drugs to avoid w acute intermittent porphyria
Barbs, etomidate, glucocorticoids, hydralazine
Acute intermittent porphyria: presentation
Abd pain, psych symptoms, delirium, seizures, neuropathy, coma
Acute intermittent porphyria: anes mgmt
Hydration, glucose and heme argininate to dec ala synthase activity, prevent hypothermia
Methohexital induc dose
1 mg/kg
How precedex resp and cns fx diff from other induc agents
Resp= no change in co2 response curve slope. Dec CBF but nochange in cmro2 and ICP
What benzos cant do that prop and barbs can cns wise
Isoelectric eeg
Potency benzos greatest to least
Ativan, midaz, valium
