Anesthesia - Induction

Question 1

Commonly used injectable induction agents?

Answer 1

Alfaxalone (common in SA), ketamine (important for LA), propofol

Question 2

Alfaxalone drug category and effect?

Answer 2

Neuroactive steroid; enhances activity of inhibitory GABA receptors in CNS

Question 3

Analgesic effects of alfaxalone?

Answer 3

None

Question 4

Considerations/side effects when using alfaxalone?

Answer 4

Minimal CV depression
Moderate resp depression
Rapidly metabolized (good for TIVA)
Recovery can be rough

Question 5

Ketamine drug class and effect?

Answer 5

Cyclohexanone; NMDA receptor antagonist - uncouples sensory and motor systems in the brain. Dissociative anesthetic

Question 6

Considerations/side effects when using ketamine?

Answer 6

Causes muscle rigidity - must also use muscle relaxants (i.e. alpha 2’s or benzos)
Sympathetic stimulant - may inc. HR/contractility
Minimal resp depression
Inc. intracranial and intraocular pressure due to muscle contractility
May exacerbate ventricular arrhythmias by increasing circulating catecholamine levels
Possible rough recovery

Question 7

Propofol drug class and effect?

Answer 7

Hindered phenol; enhances activity at inhibitory GABA receptors

Question 8

Analgesic effects of propofol?

Answer 8

None

Question 9

Considerations/side effects when using propofol?

Answer 9

Moderate CV and resp depression (dose and rate dependent)
Easily metabolized (good for TIVA)