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Anestezjo > Intravenous > Flashcards

Intravenous Flashcards

1
Q

Iv anaesthetics

A

include propofol, etomidate, ketamine, and barbiturates (e.g., thiopental)

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2
Q

standard drug for induction of anesthesia

A

Propofol

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3
Q

most commonly used in cases of hemodynamic instability

A

Etomidate

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4
Q

plays a key role in emergency medicine because of its strong dissociative, sympathomimetic, and analgesic effects

A

Ketamine

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5
Q

reduces intracranial pressure, making it useful in patients with high intracranial pressure and/or head trauma

A

Thiopental

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6
Q

Propofol

A

TIVA, induction ant maintenance
Sedative/hypnotic

an agonist on GABAa receptors and sodium channels of the reticular formation.
Rapid onset and recovery

Onset ~ 40 sec

90% protein binding
-Rapid sequence induction (ET intubation with rapid induction of unconsciousness followed by admin of a paralytic agent)
-Sedation in ICU
-Short procedures

↓ICP, BP, HR, CO, SVR and RR
hypnotic, antiemetic, and anticonvulsant, amnestic
Antipruritic
-No analgesic or muscle relaxant effects
-hepatic + extra- metab - green conj in urine

Av Eff:
Dose dependent hypotension (impair barorfx)
respiratory depression - hypoxia, apnea + BDZ synergy
Propofol infusion syndrome
Fat overload syndrome
Inj site pain, allergy - egg/soy

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7
Q

Propofol infusion syndrome

A

High doses-prolonged
1.Severe metab acidosis
2. renal/cardiac Failure
3. Rhabdomyolisis
ELEVATED TG!!!

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8
Q

Propofol doses

A

1-2 mg/kg bolus + 0,5 mg/kg every 3-5 min

(1mg/kg iv in mixture)
TIVA 6-12 mg/kg/h

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9
Q

the drug of choice for TIVA, especially for patients with an intermediate to high risk of postoperative nausea and vomiting (PONV).

A

Propofol

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10
Q

TIVA

A

Total intravenous anesthesia (TIVA)
A technique for induction and maintenance of general anesthesia using IV drugs alone, w/o inhalational agents

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11
Q

etomidate

A

Acts on the GABA receptors in the reticular formation
Rapid onset and recovery
Only iv, induction
Hypnotic effects
↓ Intracranial pressure
Anticonvulsant effects
Little to no effect on the cardiovascular system
= Anesthesia for patients with hemodynamic instability
No analgesic or muscle relaxant effect

Transient acute adrenal insufficiency
Post-op N/V
Myoclonus (disinhibitory effect), painful inf, porfiric crisis

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12
Q

Etomidate dose

A

/eto-sto 100mcg/
0.1-0.3 mg/kg
+ 0.05 mg/kg every 3-5min

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13
Q

Ketamine

A

Ideal emergency anesthesia for polytrauma patients; ICU sedation
Short painful procedures (e.g., fracture reduction)
Treatment-resistant asthma
Treatment-resistant depression

NMDA receptor antagonism → dissociative anesthesia (state with analgesia, intact reflexes, spontaneous breathing, amnesia, and no complete loss of consciousness)
sympathomimetic effects: increased BP, HR, CO
Increased cerebral blood flow, ↑ Intracranial pressure
ANALGESIA!!
#Bronchodilation - Treatment-resistant asthma
Acute psychotomimetic effects: disorientation, hallucinations, vivid dreams, nightmares (BDZ to prevent), nystagmus, ↑ Oxygen demand and ↑ pulmonary arterial pressure,
↑ Salivation, emetogenic

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14
Q

Ketamine doses

A

(1-5-10)
Iv 1-2 mg/kg - onset 1 min
Im 5-10 mg/kg - onset 5-15 min
0,2-0,5 iv to facilitate fx positioning
Oral - onset 30 min

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15
Q

Thiopental

A

Iv induction (esp., short procedures, in case of risk of raised intracranial pressure during the operation - for brain edema)
Sedation for electroconvulsive therapy (e.g., methohexital), in status epilepticus
Convulsion during or after anesthesia

80% protein bind!!
Twelve % free unionized
↓ ICP, as well as sedative, hypnotic, and antiepileptic effects
High lipid solubility (rapid distribution into fat)

rapid onset of action due to quick transfer across the blood-brain barrier → brief recovery time due to redistribution into skeletal muscles and adipose tissue

Little to no analgesic or muscle relaxant effects
Decreased IOP 40%,

Hypotension, respiratory depression, apnea
COMPENSATORY tachy<3
Laryngospasm, bronchospasm (due to histamine release)
Myoclonus
Painful injection
Visual hallucinations
Vivid dreams
Bradycardia, arrhythmias
Polphyric crisis, anaphylactic
Endothelial damage when intra-arterial inj
↓ Intracerebral blood flow
Cytochrome P450 induction

Contraindications:

Hypersensitivity
Severe cardiovascular decompensation; conditions in which a decrease in blood pressure would be hazardous
Porphyria
Addison disease
Liver or kidney disease
Severe anemia
Thyroid disorders
Myasthenia gravis
Asthma

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16
Q

Thiopental doses

A

three
Induction 3-7 mg/kg iv
Single dose induce rapid gen.anesthesia>5-10 min duration

17
Q

Metoclopramide

A

D2 antagonist, serotonin receptor antagonist
Central antiemetic effect at the area postrema
Peripheral antiemetic effect in the gastrointestinal tract (prokinetic effect); causes increase in :
Gastric contractions
Duodenal and jejunal motility
Resting tone of the lower esophageal sphincter
Together with decreased pylorus sphincter activity allows food to pass more quickly through the stomach and the small intestine
No influence on colon motility

18
Q

5 HT3 antag

A

5-HT3 antagonist
Strong central antiemetic effect at the area postrema
Peripheral antiemetic effect via inhibition of the vagus nerve

Ondansetron is commonly used for generalized nausea.
Chemotherapy-induced vomiting, radiation-induced vomiting, and postoperative nausea and vomiting (PONV)

19
Q

Antihistamines antiemetic

A

H1 antagonist
Central antiemetic effect at the area postrema and vestibular system

Strong sedative
Nausea and vomiting due to vestibular causes
Hyperemesis gravidarum
Dimenhydrinate, diphenhydramine

20
Q

BDZ classification

A

Short-acting (half-life 1–12 hours): midazolam, triazolam /short - trimiga/
Intermediate-acting (half-life 12–40 hours): lorazepam, temazepam, oxazepam, lormetazepam, alprazolam
Long-acting (half-life > 40 hours): diazepam, chlordiazepoxide, clonazepam, tetrazepam, flurazepam

Preoperative and procedural sedation: diazepam, lorazepam, midazolam

21
Q

BDZ effects

A

Anxiolysis
Sedation
Hypnotic action
Muscle relaxation
Anticonvulsant action
Amnesia

SaHaRaa

Benzodiazepines increase the frequency of chloride channel opening, whereas barbiDURATes increase the DURATion of chloride channel opening.

22
Q

Flumazenil

A

Mechanism of action: competitive antagonism at GABA receptor
Indications
Severe respiratory depression
Overdose in benzodiazepine-naive patients (e.g., accidental ingestion in children, periprocedural oversedation with benzodiazepines)
In head-injured to increase ICP
May provoke abrupt withdrawal effect

23
Q

Midazolam

A

Lipid and water soluble
Premed im 0,1 mg/kg
Sedation iv 0,01-0,1
Induction 0,1-0,4 mg/kg
Usually 1-5 mg
~5 min between doses (onset time)
Duration 0,5-2h

24
Q

Dexmedetomidine

A

In TIVA - preffered
Low resp depression risk

/ASASyn/
Anxiolytic, sedative, anelgesic, SY-lytic
Selective a2 agonist
Titrate starting at 0,6mcg/kg/h

Ketodex - with ketamine

25
Q

Deep sedation - drugs

A

Midazolam, fentanyl

Propofol, etomidate

26
Q

TIVA indications

A

Malignant hyperthermia susceptibility.
Long QT syndrome.
History of severe PONV.
Surgery requiring neurophysiological monitoring.
Anesthesia in non-theatre environments.
Transfer of anesthetized patients between different locations.
Sedation in intensive care.
Tubeless ENT procedures and rigid bronchoscopy.
Neuromuscular disorders.
Difficult intubation

27
Q

If bradycardia

A

Atropine

28
Q

When tachycardia

A

Bb

29
Q

When hypotension

A

Efedrine
Adrenaline, dopamine

30
Q

When hypertension

A

Clonidyne (catapres)

Anestezjo (12 decks)

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