Induction for the CV Patient - Quiz 3 Flashcards
What types of meds should be available and preprogrammed for CV cases?
Inotrope
Pressor
Vasodilator
Antiarrythmics
Anticoagulants & Reversals
Bolus Syringes
How should CV patients be premedicated before surgery?
Continue B-Blockers
Hold ACE & ARBS 24hrs before surgery
Anxiolytics
How does Sufentanil compare to Fentanyl?
7-10x more potent than Fentanyl
Shorter Half Life
Higher pKa
Lower Volume Distribution
How does Remifentanil compare to Fentanyl?
Similar Potency
Eliminated via Liver & Esterases
More Post-Op Pain & Hyperalgesia
What are high dose opioid techniques?
Morphine 1-2mg/kg
Fentanyl 50-100 mcg/kg
Sufentanil 10-25 mcg/kg
What is the rationale for High Dose Opioid Techniques?
Supresses Stress Response
&
Hemodynamic Stability
What is the Induction dose for Fentanyl?
3 - 10 mcg/kg
Large Volume Distribution
What is the Induction dose for Sufentanil?
0.1 - 1 mcg/kg
What is the Induction dose for Remifentanil?
0.5 - 1 mcg/kg
1 Minute Onset
9-20 min Recovery Time
How is Remifentanil Hyperalgesia treated?
Ketamine & Magnesium Sulfate
What Hypnotics are used for Induction?
Propofol
Etomidate
Ketamine
What is the Induction dose for Propofol?
1 - 2 mg/kg
Comes off quick d/t big redistribution
What are the CV effects of Propofol?
↓SVR
↓MAP
↓Cardiac Index
↓Stroke Volume
What is the Induction dose for Etomidate?
0.2 mg/kg
What are the CV effects of Etomidate?
Small MAP & SVR decrease
↑HR
↑CO
When would you want to avoid using Etomidate?
Patients w/ Seizures - can initiate myoclonus
&
High Incidence of PONV
How does Etomidate affect Cortisol / Adrenal Response?
Profound supression for 24 hrs & Hypotension
What is the Ketamine Induction dose?
2 mg/kg
What does Ketamine do?
Causes Cataleptic Trance & Dissociative Anesthesia
Unconscious in 20-60 sec
What are the CV effects of Ketamine?
↑HR
↑MAP
↑Plasma Epi
↑Coronary Demand
What are the Neuro effects of Ketamine?
↑ICP
Inhibits Tumor Necrosis Factors –> Anti Inflammatory & Antihyperanalgesic Effects
EEG Theta Waves
Which receptor does Ketamine work on?
Noncompetitive NMDA Antagonist
What are the CV effects of Inhalation Agents?
Myocardial Depression
Dose-Dependent Vasodilation
Dose-Dependent Tachycardia - especially Des
Out of Des, Sevo, and Isoflurane, which gas has the least Dose-Response relationship in regards to MAP
Sevoflurane
________ is a short acting NMB
Succinylcholine
Which NMBs are Intermediate Acting?
Cisatracurium
Rocuronium
Vecuronium
(Longer Onset & Acting than Roc)
Which NMB is Long Acting?
Pancuronium - Vagolytic effect to counter opioids
How do pts w/ HTN react to Induction Agents & Larygoscopy?
More HTN to Laryngeal Stimulation & More Hypotensive to Induction Agents
How does Propofol Distribute throughout the body?
Quickly to Brain & Highly Perfused Areas, then to less perfused areas.
Metabolized by Liver & pt breathes it off
What is the Induction dose for Precedex?
Loading: 1mcg/kg in 10 min (None in CABGs)
Infusion: 0.2 - 1.5 mcg/kg/hr
What are the Neuro effects of Precedex?
Natural Sleep Sedation
No CMRO2 Change
↓Cerebral Blood Flow
What are the CV Effects of Precedex?
Hypotension & Bradycardia d/t vasodilation
Loading Dose HTN
No Contractility Change
True/False: Fentanyl is metabolized by the liver into active metabolites?
False - broken down by liver into inactive metabolites
What is the difference b/t Ephedrine & Epinephrine?
Similar, but Ephedrine has longer duration & does NOT increase glucose levels
Decreases in effectiveness over time
Which receptors does Esmolol work on?
Beta 1
Fast Onset
Short Half-life d/t Plasma Esterase Metabolism
Which vasopressor increases coronary artery perfusion & preload?
Norepinephrine
⬆Coronary perfusion d/t ⬆DBP
First line for CV cases
How does Milrinone work?
PDE3 Inhibitor - prevents cAMP breakdown
Inotrope & Vasodilation w/o Tachycardia
↓Preload & ↓Afterload
