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*2Topics Anesthesia Oral Boards > Anesthetic Medications > Flashcards

Anesthetic Medications Flashcards

1
Q

Metabolism of Propofol

A

Rapidly metabolized in liver to water-soluble compounds, then excreted by kidneys

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2
Q

CNS effect of Propofol

A

Decreases CMRO2, CBF, ICP, IOP, CPP

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3
Q

Respiratory effects of Propofol

A
  • Apnea w/ induction dose
  • Decrease TV and increase RR
  • Bronchodilation in COPD patient
  • DOES NOT inhibit hypoxic pulmonary vasoconstriction
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4
Q

Cardiovascular effects of Propofol

A
  • Decreases SBP, DBP, and MAP
  • Decreases CO, CI, SVR, and stroke index
  • No reflex tachycardia
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5
Q

S/s of Propofol Infusion Syndrome (PRIS)

A
  1. Cardiomyopathy
  2. Rhabdomyolysis
  3. Severe Metabolic Acidosis
  4. Hyperkalemia
  5. Hepatomegaly
  6. Lipemia
  7. Renal Failure
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6
Q

Contraindications to Barbituates

  • Thiopental
  • Methohexital
A
  1. Patients w/ respiratory obstruction or inadequate airway
  2. Severe CV instability or shock
  3. Status asthmatics
  4. Porphyria
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7
Q

CNS effect of Ketamine

A
  1. Increased CMRO2, CBF, ICP
  2. Maintains many reflexes: corneal, cough, and swallow
    • still at risk for aspiration
  3. Analgesia
  4. Pupils dilate
  5. Nystagmus
  6. Increased muscle tone
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8
Q

Respiratory effect of Ketamine

A
  1. Minimal effect on central respiratory drive
  2. Unaltered response to CO2
  3. Bronchodilation
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9
Q

Cardiovascular effect of Ketamine

A
  1. Stimulates sympathetic system
  2. Increased CO, HR, and BP
  3. Increased O2 consumption
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10
Q

Indications for Inducing w/ Ketamine

A
  1. Patients w/ reactive airway disorders
  2. Healthy trauma w/ unknown blood loss
  3. Cardiac tamponade
  4. Restrictive pericarditis
  5. Congenital Heart disease
  6. Septic Shock
  7. Hemodynamic compromise based on hypovolemia or cardiomyopathy
  8. R->L cardiac shunt
  9. Remote location: dressing changes, radiation therapy, dental work
  10. Tx for opioid resistance: chronic pain
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11
Q

Side effects of Ketamine

A
  1. Increased lacrimation and salivation
    • Increases risk of laryngospasm
  2. Increased skeletal muscle tone
  3. Increased ICP
  4. Emergence reactions: excitement, confusion, illusions (tx w/ benzo), vivid dreams
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12
Q

Contraindications to Ketamine

A
  1. Open eye injury: increases IOP
  2. Significant CAD
  3. Vascular aneurysm
  4. Schizophrenia
  5. Patient w/ increased ICP or intracranial mass
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13
Q

CNS effect of Etomidate

A
  1. Hypnosis
  2. No analgesic activity
  3. Reduced CBF and CMRO2
  4. CPP is maintained or increased
  5. Reduced ICP and intraocular pressure
  6. Cerebral protection
  7. Induces increased EEG activity and myoclonic activity
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14
Q

Cardiovascular effect of Etomidate

A
  1. Hemodynamic stability

2. Minimal change in HR, MAP, mean pulmonary pressure, CVP, SV, CI, or SVR

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15
Q

Respiratory effect of Etomoidate

A
  1. Minimal respiratory depression

2. May not totally ablate sympathetic response to laryngoscopy and intubation

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16
Q

Indications for Etomidate

A

Patient w/:

  1. H/o cerebral vascular accident
  2. CAD
  3. Reactive airway disease
  4. Increased ICP
  5. Aortic surgery
  6. Neurosurgical patients
  7. Aortic surgery
  8. Cardioversion
  9. Trauma patient
  10. Retrobulbar block
  11. ECT (can induce seizures)
17
Q

Side Effects of Etomidate

A
  1. Suppresses adrenal-cortical function
    • Inhibits 11-beta-hydroxylase
  2. Pain on injection
  3. Superficial thrombophlebitis
  4. Myoclouns
  5. Nausea and vomiting
18
Q

Disadvantages of Isoflurane

A
  1. High blood and lipid solubility
    • Slower onset and emergence
  2. Pungent odor - bad for inhalational induction
  3. May produce tachycardia
  4. Possible Coronary Steal
19
Q

Nitrous Oxide: Concentration effect

A
  1. Combination of low solubility and high inhaled partial pressures
  2. Increases blood concentration of NO2
  3. Speeds induction
20
Q

Nitrous Oxide: Diffusion Hypoxia

A
  • Occurs during emergence if low FiO2 used
  • Opposite of concentration effect
    • Rapid diffusion of NO2 from blood to the alveoli decreases the alveolar PO2
21
Q

Nitrous Oxide: Second Gas Effect

A
  1. Same principle as concentration effect

2. Rapid diffusion of NO2 from alveoli to blood increases alveolar concentration of volatile agent

22
Q

Disadvantages of Nitrous Oxide

A
  1. Very high MAC (104%) - can’t be used as sole agent
  2. Will expand gas-filled spaces
    • Don’t use in pneumothorax, pneumocephalus, pHTN, or intestinal obstruction
    • Don’t use in certain eye or inner ear surgery
    • Don’t use if high risk for Venous Air Embolism
  3. Increase risk of PONV
  4. Inactivates Vitamin B12

*2Topics Anesthesia Oral Boards (10 decks)

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