Anesthetic Adjuncts

Question 0

Hydromorphone

Answer 0

Dilaudid , Opioid

Agonist

Question 1

Morphine

Answer 1

Contin , Opioid

Agonist

Question 2

Oxymorphone

Answer 2

Oxycontin , Opioid

Agonist

Question 3

Fentanyl

Answer 3

Actiq , Duragesic
Opioid
Agonist

Question 4

Meperidine

Answer 4

Demerol , Opioid
Agonist
Only opioid with antimuscarinic effect, tachycardia

Question 5

Remifentanil

Answer 5

Ultiva , Opioid

Agonist

Question 6

Buprenorphine

Answer 6

Buprenex
Opioid
Partial agonist

Question 7

Butorphanol

Answer 7

Stadol
Opioid
Agonist-antagonist

Question 8

Nalbuphine

Answer 8

Nubain
Opioid
Agonist-Antagonist

Question 9

Pentazocine

Answer 9

Talwin
Opioid
Agonist-antagonist

Question 10

Naloxone

Answer 10

Narcan
Opioid antagonist
IM - 5 min to reversal , IV - 2 min to reversal
Duration 30-60 min

Question 11

Naltrexone

Answer 11

Depade , Revia
Opioid antagonist
Longer acting than narcan with potential liver toxicity

Question 12

Tramadol

Answer 12

Opioid-LIKE , Given PO
Weak centrally acting mu receptor agonist
Moderate analgesia , fibromyalgia
Serotonin syndrome

Question 13

Thiopental

Answer 13

Ultra short acting , thiobarbiturate

Redistributed into muscle and fat with slow release

Question 14

Methohexital

Answer 14

Ultra short acting , oxybarbiturate

Redistributed to muscle and fat with FAST release

Question 15

Phenobarbital

Answer 15

Long acting , oxibarbiturate
Slow release from the brain depending on renal excretion
Seizures

Question 16

Pentobarbital

Answer 16

Short acting , oxybarbiturate
Brain levels decrease based on liver metab
Faster than kidney excretion

Question 17

Propofol

Answer 17

PropoFlo , Diprivan , Ultra short acting nonbarbiturate
Metab by liver , excreted by kidneys
Primarily terminated by redistribution
Function half life 3 min, elimination half life 2-4 hours
10 mg/mL , onset 45 secs , duration 5-10 min
Bolus repeated every 3-5 minutes for 20 min

Question 18

Ketamine hydrochloride

Answer 18

Disassociative anesthetic
Awake but unaware of surroundings , Waxy rigidity
Peak effect 1-2 min IV, 10 min IM, Duration 20-30 min
Avoid disassociatives in liver and renal disease. Use in peds

Question 19

Etomidate

Answer 19

Amidate
Sedative, hypnotic, no analgesic
IV induction used but can be painful
No cardiac or resp effect
Onset of action: 30–60 seconds 
Peak effect: 1 minute, Duration: 3–5 minutes
terminated by redistribution 
Distribution: Vd: 2-4.5 L/kg 
Protein binding: 76% Metabolism: Hepatic and plasma esterases Half-life redistribution: 29 minutes 
Half-life elimination: 2.9 to 5.3 hours

Question 20

Valium

Answer 20

Diazepam , benzodiazepine
Tranquilizer, Half life 1-4 days
Not water soluble, store in dark plastic

Question 21

Lorazepam

Answer 21

Ativan
Water soluble, dec use in surgery
DOC for stimulant overdose
Highly addictive , anterograde amnesia
Half life 10-20 hrs

Question 22

Midazolam

Answer 22

Versed
Water soluble , IM or SC
Commonly used with propofol for surgery
Half life 2-6 hours

Question 23

Flumazenil

Answer 23

Anexate
Benzodiazepine reversal
Competitive inhibition at GABA receptor

Question 24

Halothane

Answer 24

Rapid induction and recovery
Not explosive
Somewhat arrythmogenic , hepatotoxic
Can contribute to malig hyper esp when used with SUX

Question 25

Isoflurane

Answer 25

Most common in North America
High vapor pressure: need a precision vaporizer
Low blood:gas partition coefficient: rapid induction and recovery
Good for induction with mask or chamber
MAC = 1.3% to 1.63%: helps determine initial vaporizer setting
Low rubber solubility
Stable at room temperature; no preservatives needed
Maintains cardiac output, heart rate, and rhythm
Fewest adverse cardiovascular effects
Depresses the respiratory system
Maintains cerebral blood flow
Almost completely eliminated through the lungs
Induces adequate to good muscle relaxation
Provides little or no analgesia after anesthesia
Can produce carbon monoxide when exposed to a desiccated carbon dioxide absorbent

Question 26

Sevoflurane

Answer 26

High vapor pressure: needs a precision vaporizer
Blood:gas partition coefficient: rapid induction and recovery
Good for induction with a mask or chamber
High controllability of depth of anesthesia
MAC = 2.34% to 2.58%
Minimal cardiovascular depression
Depresses respiratory system
Eliminated by the lungs, minimal hepatic metabolism
Maintains cerebral blood flow
Induces adequate muscle relaxation
Some thrashing, etc. and excitement during recovery

Question 27

Desflurane

Answer 27

Closely related to isoflurane
Expensive
Lowest blood:gas coefficient: very rapid induction and recovery
Used with a special precision vaporizer
MAC = 7.2% and 9.8% – Least potent inhalant agent
Eliminated by the lungs

Question 28

Nitrous oxide

Answer 28

Excellent analgesic, poor anesthetic (by itself)
Doesn’t require a precision vaporizer
Often mixed with other gas anesthetics to produce better analgesia (NEVER more than 80% N2O!)
Very poorly soluble in blood and tissues
Only used as adjunct