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Induction Agents Flashcards

1
Q

Propofol Dosing

A
  • Induction: 1-2.5 mg/kg OR 2 mg
  • Sedation maintenance: 25-200 mcg/kg/min
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2
Q

Propofol Onset/Duration

A

Onset: 30 sec
Duration: dose & rate dependent

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3
Q

Propofol MOA

A
  • GABAa agonist (stimulates these receptors)
  • Highly lipid soluble
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4
Q

Propofol contraindications

A
  • soy allergy
  • egg allergy (proteins trigger egg allergy; prop is made from egg white; still avoid to be safe)
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5
Q

Propofol CV effects?

A
  • decrease HR
  • decrease SVR
  • decrease BP
    not a good choice for low CO states, hypovolemia, and hypotension
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6
Q

Propofol CNS effects?

A
  • decrease CBF
  • decrease ICP
  • decrease CMRO2
  • loss of consciousness
  • anticonvulsant
  • minimal residual CNS effects due to fast on/fast off
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7
Q

Propofol respiratory effects?

A
  • respiratory depression (dose-dependent)
  • apnea
  • bronchodilation
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8
Q

Propofol protein binding

A

97 - 99%

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9
Q

How is propofol metabolized?

A
  • mostly by the liver
  • kidney and lungs (30%)
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10
Q

When is propofol used?

A
  • TIVA
  • induction
  • outpatient surgery
  • endoscopy
  • MAC
  • antiemetic (10-15mg)
  • antipuritis (10mg)
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11
Q

Propofol bacteria considerations

A
  • 12 hours in an opened infusion vial
  • 6 hours in a syringe
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12
Q

Elderly considerations with propofol?

A

more sensitive and prolonged effects due to decreased CO and clearance (may need lower dose)

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13
Q

Pediatric considerations with propofol?

A

may need larger dose because of larger Vd and quicker clearance

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14
Q

Obesity considerations with propofol?

A

base dosing on lean body weight (LBW), NOT by actual body weight

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15
Q

In what cases would a patient need higher doses of propofol due to decreased sensitivity?

A
  • chronic alcoholism
  • daily marijuana use
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16
Q

In what cases would a patient need lower doses of propofol due to increased sensitivity?

A
  • CV disease
  • elderly
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17
Q

What can we expect with higher doses of propfol and rapid clearance?

A

ramped up liver enzymes

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18
Q

Lidocaine Dosing

A

0.5 - 1.5 mg/kg

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19
Q

What is the concentration of 1% lidocaine?

A

10 mg/ml

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20
Q

What is the concentration of 2% lidocaine?

A

20 mg/ml

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21
Q

When is lidocaine used?

A
  • suppress coughing reflex during laryngoscopy, intubation, and EGD
  • reduce airway responsiveness to noxious stimuli
  • reduce pain caused by IV injection agents
  • drip for ERAS protocols (enhanced recovery after surgery)
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22
Q

What can be used to decrease painful injection of propofol?

A

lidocaine

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23
Q

Lidocaine is given at a dose of ______ and administered _______ minutes before intubation or extubation to __________ and _________

A
  • 1.5mg/kg
  • 3 min
  • suppress cough reflex
  • attenuate the increase in airway resistance from laryngoscopy and intubation
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24
Q

Careful for lidocaine use in _________ patients due to ___________

A
  • cardiac patients
  • hypotensive effects
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25
Q

What is the effect of lidocaine on CBF?

A

decrease CBF and attenuate intracranial hypertensive response to laryngoscopy and intubation

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26
Q

What is the most common and effective ERAS lidocaine drip dosing?

A

1-2 mg/kg/hr

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27
Q

What is the rationale for administering a lidocaine infusion per ERAS protocol?

A
  • analgesia
  • ANTI-hyperalgesia
  • ANTI-inflammatory
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28
Q

What is the concentration in a lidocaine infusion bag?

A

4 mg/ml
1 gm lidocaine in 250ml
OR
2 gm lidocaine in 500 ml

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29
Q

What is the MOA of ketamine?

A
  • noncompetitive NMDA receptor antagonist that blocks glutamate
  • stimulates SNS; inhibits reuptake of norepinephrine
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30
Q

Ketamine is considered a ___________ anesthetic

A

dissociative anesthetic

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31
Q

What is ketamine used for?

A
  • induction
  • sedation
  • patients with CV collapse
  • sedation for mentally challenged
  • “bad” epidural/spinal
  • trauma induction
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32
Q

Ketamine CV effects?

A
  • increase in BP
  • increase in HR
  • increase in CO
  • increase in PAP
  • increase in CVP
  • increase in CI
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33
Q

Ketamine respiratory effects?

A
  • minimal respiratory depression
  • able to maintain upper airway reflexes
  • increased oral secretions (may give 0.2mg of glycopyrrolate)
  • major bronchodilator (great for patient that is actively wheezing)
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34
Q

Ketamine stimulates SNS or PNS? What effects will be seen?

A
  • stimulates SNS
  • increased HR, SVR, BP
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35
Q

How does ketamine cause intense analgesia?

A

Binds to opioid receptors (mu, kappa, delta)

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36
Q

Children are at risk for ___________ when administered ketamine

A

emergence delirium

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37
Q

What are ways to prevent emergence delirium with ketamine?

A

wake up in low lights, quiet room, no cartoons on TV, administer versed

38
Q

What agent can be given to prevent emergence delirium with ketamine?

39
Q

Ketamine Dosage

A

IV: 1-2 mg/kg
IM: 4-5 mg/kg

40
Q

Ketamine onset and duration

A

Onset: 30 sec (IV), 2-4 min (IM)
Duration: 10-15 min (IV), 15-25 min (IM)

41
Q

____________ is an active metabolite of ketamine. It is ________________ potent as ketamine

A
  • norketamine
  • 1/3 - 1/5
42
Q

What agent is considered a phencyclidine derivative and hallucinogenic?

43
Q

Ketamine is part of what protocol?

A

bronchospastic protocol

44
Q

Bronchospastic protocol treatments

A
  1. 100% O2
  2. change I:E for longer exhalation
  3. deepen volatile anesthetic
  4. r/o mainstem intubation or kinked ETT. suction
  5. inhaled beta 2 agonist or anticholinergic
  6. epi 10 mics (if severe)
  7. ketamine 0.2 - 1.0mg/kg
  8. hydrocortisone 100mg
  9. nebulized racemic epi
  10. r/o anaphylaxis
  11. ABG
45
Q

Thiopental Dosing

A

3-5 mg/kg IV

46
Q

Thiopental onset and duration

A

Onset: 30-60 sec
Duration: 5-30 min

47
Q

How is thiopental metabolized?

A

hepatic metabolism

48
Q

What is thiopental used for?

A
  • sedative/hypnotic
  • anticonvulsant
  • treatment of ICP
  • induction of anesthesia
49
Q

What are contraindications to administering thiopental?

A
  • acute intermittent porphyria (variegate porphyria)
  • status asthmaticus
50
Q

Protein binding of thiopental?

51
Q

Thiopental MOA

A

short acting barbituate that activates GABA receptors

52
Q

T/F: Thiopental is a benzodiazepine

A

false
thiopental is a barbiturate (thiobarbiturate)

53
Q

What is the effect of thiopental on BP?

A

hypotension

54
Q

What is the effect of thiopental on CNS?

A
  • sedation
  • LOC
  • decrease in CBF
  • decrease in ICP
55
Q

T/F: Thiopental has some histamine release

56
Q

Which drug is still studied in anesthesia but no longer used in the US?

A

thiopental

57
Q

T/F: thiopental does not cause nausea/vomiting

A

false
thiopental may increase N/V

58
Q

Thiopental may cause ____________, which can lead to _______________

A
  • extravasation
  • necrosis
59
Q

Etomidate Dosing

A

0.2 - 0.3 mg/kg

60
Q

Etomidate onset and duration

A

Onset: 30 - 60 sec
Duration: 2 -3 min

61
Q

Protein binding of etomidate

62
Q

Mechanism of action of etomidate

A
  • ultrashort-acting non-barbiturate hypnotic
  • depresses RAS via activating GABA
63
Q

What are the uses for etomidate?

A
  • induction
  • procedural sedation
64
Q

Etomidate CV effects?

A

minimal CV effects

65
Q

Etomidate CNS effects?

A
  • decrease CMRO2
  • decrease CBF
  • decrease ICP
  • sedation
  • LOC
  • myoclonic movements
66
Q

Etomidate has the potential to cause _____________ which can be decreased with opioids

A

myoclonic movements

67
Q

Etomidate respiratory effects?

A

respiratory depression

68
Q

What is a major risk of etomidate?

A

adrenocortical suppression

69
Q

Why don’t we use etomidate for long-term use?

A

Potential for adrenocortical suppression

70
Q

How is etomidate metabolized?

A

hepatic enzyme and plasma esterase hydrolysis

71
Q

Dexmedetomidine MOA

A
  • highly selective and potent alpha2 adrenergic agonist
  • inhibits norepinephrine release
72
Q

When is dexmedetomidine used?

A
  • sedation
  • analgesia
  • anxiolysis
  • awake fiberoptic intubation
  • postop sedation
  • post exubation to keep calm
  • pediatrics
73
Q

CV effects of dexmedetomidine?

A
  • BRADYCARDIA (esp with bolus)
  • sinus arrest
  • hypotension
74
Q

How are CV effects from dexmedetomidine treated?

A
  • atropine
  • ephedrine
  • volume/fluids
75
Q

T/F: dexmedetomidine has minimal respiratory depression effects

76
Q

Protein binding of dexmedetomidine?

77
Q

Dexmedetomidine Dosing

A
  • Procedural sedation: 0.5 - 1 mcg/kg bolus over 10 min, then 0.3 - 0.7 mcg/kg/hour infusion
  • Awake fiberoptic intubation: 1 mcg/kg bolus over 10 min, then 0.7 mcg/kg/hour infusion
78
Q

Dexmedetomidine onset, peak, and duration

A

Onset: 5-10 min
Peak: 15-30 min
Duration: 60-120 min

79
Q

How is dexmedetomidine metabolized and excretion?

A
  • hepatic metabolism
  • urinary excretion
80
Q

What is methohexital used for?

A
  • electroconvulsive therapy (ECT)
  • endoscopy
  • very short procedures
81
Q

Methohexital MOA

A
  • GABA agonist
  • rapid ultrashort-acting barbiturate
82
Q

T/F: methohexital is a barbiturate

A

true
methohexital is an oxybarbiturate

83
Q

Methohexital Dosing

A

1 - 1.5 mg/kg

84
Q

Methohexital onset and duration

A

Onset: < 1 min
Duration: 5 - 7 min

85
Q

T/F: methohexital is the shortest acting barbiturate

86
Q

Methohexital has _____________ activity and ____________ seizure threshold, which is why it is good for ____________

A

Methohexital has PROCONVULSANT activity and LOWERS seizure threshold, which is why it is good for ECT

87
Q

Methohexital must be ______________ into a ____________ solution in ___________

A
  • reconstituted
  • 1% (10 mg/ml) solution
  • in sterile water
88
Q

Effect of methohexital

A
  • deep sedation
  • skeletal muscle hyperactivity
89
Q

T/F: methohexital is not painful on injection

A

false
methohexital is painful on injection

90
Q

How is methohexital metabolized and excreted?

A
  • hepatic metabolism
  • urinary excretion
91
Q

Why does methohexital have short onset and duration?

A

RAPID distribution and RAPID redistribution

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