General Anesthetics Flashcards
Propofol (Diprivan) Other SE
Painful injection site; supports bacterial growth
Nitrous Oxide Class
Inorganic gas
Isoflurane (Forane) Class
Volatile anesthetic
Propofol (Diprivan) Class
Alkylphenol (a fatty acid)
Etomidate (Amidate) Class
Carboxylated imidazole
Ketamine (Ketalar) Class
Phencyclidine
Succinylcholine (Anectine) Class
Depolarizing NMB
Pancuronium (Pavulon) Class
Amino steroid non-depolarizing NMB
Vecuronium (Norcuron) Class
Amino steroid non-depolarizing NMB
Edrophonium (Enlon) Class
AChE-I
Neostigmine (Prostigmin) Class
AChE-I
Pyridostigmine (Mestinon) Class
AChE-I
Glycopyrrolate (Robinul) Class
Anti-muscarinic
Nitrous Oxide MOA
NMDA receptor antagonist
Isoflurane (Forane) MOA
Most potent
Propofol (Diprivan) MOA
GABAa receptor agonist, antagonist of NMDA-glutamate receptor; some a2 receptor activity; rapid onset and offset
Etomidate (Amidate) MOA
GABAa receptor agonist (only D-isomer)
Ketamine (Ketalar) MOA
NMDA receptor antagonist, kappa opiate agonist; leads to dose-dependent unconsciousness, amnesia, analgesia
Succinylcholine (Anectine) MOA
Divalent ACh molecule; attaches to all ACh receptors, overstimulating them (first seen as disorganized muscular contractions (fasiculations), then paralysis)
Pancuronium (Pavulon) MOA
Competitive blockade of ACh (no depolarization); vagolytic
Vecuronium (Norcuron) MOA
Competitive blockade of ACh (no depolarization)
Edrophonium (Enlon) Class
Neostigmine (Prostigmin) Class
Pyridostigmine (Mestinon) Class
Glycopyrrolate (Robinul) Class
Nitrous Oxide Therapeutics
Mask induction in children; adjuvant to volatile anesthetics, opioids
Isoflurane (Forane) Therapeutics
Gold standard for maintenance of anesthesia
Propofol (Diprivan) Therapeutics
Anti-emetic at low doses; induction and maintenance of general anesthesia; sedation in ICU, procedural sedation
Etomidate (Amidate) Therapeutics
Hypnosis; no analgesic activity
Ketamine (Ketalar) Therapeutics
Sedative/anesthetic for pediatric/developmentally delayed patients; induction in patients with reactive airway disease, hypovolemia (trauma patients), cardiac disease; with propofol for IV procedural sedation; adjuvant during and after surgery to reduce opiod use; part of multimodal pain therapy regimen; depression treatment
Succinylcholine (Anectine) Therapeutics
Skeletal muscle relaxant (intubation)
Pancuronium (Pavulon) Therapeutics
Skeletal muscle relaxant; avoid in patients with renal insufficiency
Vecuronium (Norcuron) Therapeutics
Skeletal muscle relaxant
Edrophonium (Enlon) Therapeutics
Reversal of NMB
Neostigmine (Prostigmin) Therapeutics
Reversal of NMB (most commonly used)
Pyridostigmine (Mestinon) Mask induction in children; adjuvant to volatile anesthetics, opioids
Gold standard for maintenance of anesthesia
Reversal of NMB
Glycopyrrolate (Robinul) Mask induction in children; adjuvant to volatile anesthetics, opioids
Gold standard for maintenance of anesthesia
Reversal of neuromuscular blockade’s muscaranic effects
Nitrous Oxide Important SE
Post-operative nausea and vomiting; inactivates vitamin B (leading to abnormal embryonic development, abortion); accumulates in closed, air-containing spaces (bowel, middle ear, pneumothoraces, air emboli) because N2O insoluble in blood
Isoflurane (Forane) Important SE
Pungent; dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; increase in HR; malignant hyperthermia
Propofol (Diprivan) Important SE
Propofol infusion syndrome: being given for several days leads to metabolic acidosis, rhabdomyolysis, heart & renal failure, lowering of BP, bradycardia, and death (likely due to fatty acid oxidation)
Etomidate (Amidate) Important SE
Pain on administration (due to solvent, propylene glycol); involuntary myoclonic movements due to subcortical disinhibition (not a seizure); post-operative nausea and vomiting; single dose inhibits cortisol synthesis
Ketamine (Ketalar) Important SE
Stimulates sympathetic nervous system outflow; increases cerebral blood flow, ICP; emergence delerium; nystagmus, lacrimation, salivation, and dissociative anesthesia
Succinylcholine (Anectine) Important SE
Malignant hyperthermia; cardiac dysrhythmias, hyperkalemia, increased intraocular pressure, increased intracranial pressure
Pancuronium (Pavulon) Important SE
Increase in HR
Vecuronium (Norcuron) Important SE
No cardiovascular effects
Edrophonium (Enlon) Important SE
Neostigmine (Prostigmin) Important SE
Pyridostigmine (Mestinon) Important SE
Glycopyrrolate (Robinul) Important SE
DUMBELLS
Nitrous Oxide Misc
No muscle relaxant
Isoflurane (Forane) Misc
..
Propofol (Diprivan) Misc
Administered IV in a lipid emulsion (cause of pain); be aware of allergies (egg and soy in emulsion); no malignant hyperthermia
Etomidate (Amidate) Misc
Minimal cardiorespiratory depression (good agent in patients with minimal cardiac reserve)
Ketamine (Ketalar) Misc
Racemic mixture (S more potent); metabolized by P450 (norketamine, a third to a fifth as effective); great bronchodilator; contraindicated in CAD patients and those with with intracranial lesions
Succinylcholine (Anectine) Misc
Hydrolyzed by pseudocholinesterase (in plasma); blockade cannot be reversed; only NMB with rapid onset and ultra-short duration of action
Pancuronium (Pavulon) Misc
Only long acting non-depolarizing agent; supplied as liquid; 80% excreted unchanged in liver (low metabolism in liver); reverse with AChEI
Vecuronium (Norcuron)Misc
Intermediate acting; supplied as a powder (reconstitute); hepatic metabolism, hepatic and renal excretion; reverse with AChEI
Edrophonium (Enlon)Misc
Short-acting, fast onset
Neostigmine (Prostigmin) Misc
More complete antagonism than edrophonium
Pyridostigmine (Mestinon)Misc
Longer duration of action than neostigmine, edrophonium
Glycopyrrolate (Robinul) Misc
Could also use atropine
Succinylcholine (Anectine) Other SE
Increased intragastric pressure, myalgias, masseter spasm
