INDUCTION AGENTS Flashcards
brand name of etomidate
amidate
how is etomidate supplied
2 mg/mL
what is the MOA of etomidate
benzylimidazole producing agonism of GABAa by binding directly to a specific site on the protein and enhancing the affinity for GABA
which receptor subunit does etomidate primarily bind to?
Beta-subunits on the GABAa receptor
induction dose for etomidate
0.2-0.6mg/kg
maintenance dose for etomidate
5-20 mcg/kg/min
MAC dose for etomidate
MAC 0.1-0.2 mg/kg
→ followed by 0.05 mg/kg every 3-5 minutes as needed
onset of etomidate
30-60 seconds
peak of etomidate
1 minute
duration of etomidate
3-5 minutes
half-life of etomidate
2.6 hours
metabolism of etomidate
hepatic and plasma esterases
best quality of etomidate i.e. s/e it has the least of
CV
endocrine se of etomidate
adrenal suppression (suppresses cortisol biosynthesis)
GI se of etomidate
N/V on emergence
derm se of etomidate
Local: pain at site 30-80%
NMS se of etomidate
NMS: Myoclonus (33%) transient skeletal movements, uncontrolled eye movements 1-10% hiccups
how does etomidate effect IOP, ICP, CMRO2 & perfusion pressure
Decreases IOP, ICP, CMRO2 BUT maintains perfusion pressure
what enzyme does etomidate inhibit
CYP 450
what conditions do you avoid etomidate with
Trauma, critical illness, sepsis (adrenal insufficiency)
why do you avoid etomidate during stress
Decreases cortisol levels
brand name of propofol
Diprivan
how is propofol supplied
10mg/mL
uses of proposal
Induction of anesthesia in patients > 3 years old
Maintenance of anesthesia > 2 month,
in adults, for monitored anesthesia care
sedation during procedures
sedation in intubated pt
onset of propofol
9-51 seconds
what effect does the dose or rate have on onset of propofol
higher dose faster onset
higher rate faster onset
duration of action of propofol
3-10 minutes
peak of propofol
9-51 s
half life of propofol
Biphasic
initial 40 minutes, terminal 4-7 hours after 10 day infusion may be unto 1-3 das
elimination of propofol
urine 88%
metabolites 40% as glucouronide metabolite
feces 2%
metabolism of propofol
hepatic to water soluble sulfate and flucuronicide conjugates 50%
adverse effects of propofol
HYPOTENSION: children 17%; adults 3% to 26%),
Movement (children 17%; adults 3% to 10%),
Injection site burning, stinging, or pain (children 10%; adults 18%),
Apnea lasting 30-60 seconds (children 10%; adults 24%), apnea lasting >60 seconds (children 5%; adults 12%),
Hypertension (children 8%), arrhythmia (1% to 3%),
bradycardia (1% to 3%),
cardiac output decreased (1% to 3%; concurrent opioid use increases incidence), tachycardia (1% to 3%),
Pruritus (1% to 3%),
rash (children 5%; adults 1% to 3%),
Hypertriglyceridemia (3% to 10%),
Respiratory acidosis during weaning (3% to 10%)
contraindications with propofol
Hypersensitivity to propofol or any component of the formulation; hypersensitivity to eggs, egg products, soybeans, or soy products; when general anesthesia or sedation is contraindicated
brand name of ketamine
katalar
how is ketamine supplied?
50mg/mL
what is the mechanism of action of ketamine?
Ketamine is a noncompetitive NMDA receptor antagonist that blocks glutamate.
Produces a cataleptic-like state in which the patient is dissociated from the surrounding environment by direct action on the cortex and limbic system.
uses of ketamine
Low (sub anesthetic) doses produce analgesia
modulate central sensitization,
hyperalgesia
opioid tolerance.
Reduces polysynaptic spinal reflexes.
Analgesia and Sedation
dose of ketamine IM for induction
I.M.: 6.5 to 13 mg/kg
dose of ketamine IV for induction
I.V.: 1 to 4.5 mg/kg
IV dose of ketamine for induction if versed if also given
(0.5-2mg/kg if versed has been given)
rapid sequence IV dose for intubation
Rapid sequence intubation: 2mg/kg IV
1-2mg/kg is most common induction dose
onset of IV ketamine
I.V.: Anesthetic effect: 30 seconds;
onset of IM ketamine
I.M.: Anesthetic effect: 3-4 minutes
DOA ketamine IV
Anesthetic effect: I.V.: 5-10 minutes;
DOA ketamine IM
I.M.: 12-25 minutes
half life of ketamine alpha and beta phase
Alpha: 10-15 minutes; Beta: 2.5 hours
excretion of ketamine
Primarily urine
metabolism of ketamine
Hepatic via hydroxylation and N-demethylation; the metabolite norketamine is 33% as potent as parent compound;
greater conversion to norketamine occurs after oral administration as compared to parenteral administration
AE ketamine CV
Cardiovascular: Arrhythmia, bradycardia/tachycardia, hyper-/hypotension,
ae ketamine GI
Anorexia,
nausea,
salivation !!!!!
increased vomiting
ae ketamine derm
Erythema (transient),
morbilliform rash (transient),
Pain at the injection site,
exanthema at the injection site,
ae ketamine MSK
Skeletal muscle tone enhanced (tonic-clonic movements
ae ketamine resp
Airway obstruction, apnea, bronchial secretions increased, respiratory depression, laryngospasm,
ae ketamine eye
Diplopia,
intraocular pressure increased,
nystagmus,
ae ketamine misc
Anaphylaxis,
ae ketamine neuro
Intracranial pressure increased dependence with prolonged use, emergence reactions (~12%; includes confusion, delirium, dreamlike state, excitement, hallucinations, irrational behavior, vivid imagery)
clinical pearls with ketamine
Increases HR, BP, CO secondary to catecholamine release.
Causes bronchodilation.
Lowers seizure threshold.
May cause emergence psychosis.
name the induction agents
etomidate ketamine propofol Methohexital Thiopental
