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Junior Anaesthesia > INTRAVENOUS ANAESTHETIC AGENTS > Flashcards

INTRAVENOUS ANAESTHETIC AGENTS Flashcards

1
Q

What are IV Anaesthetic Agents / Induction drugs?

These are drugs that, when given intravenously in an appropriate dose, cause a __________________________.

Often described as occurring within “________________________________ time”

A

rapid loss of consciousness

one arm-brain circulation

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2
Q

One-arm brain circulation time

that is simply the time taken for ____________________________________________ , where they have their effect; normally ___________

A

the drug to travel from the site of injection (usually antecubital) to the brain

10 -20 secs

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3
Q

Properties of an ideal IV induction drug

Physical / Chemical properties
• _________-soluble & _________ in solution
•(Cheap or Expensive?)
• Stable on exposure to ______
• ________ shelf-life
• No ________ on intravenous injection
• Not painful when injected into _________
• _________ when injected subcutaneously
• Low incidence of _________

A

• Water ; stable

Cheap; light

Long; No pain; an artery

Non-irritant ; thrombophlebitis

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4
Q

Properties of an ideal IV induction drug  Pharmacokinetic properties

•_____________ in one arm-brain circulation time
•_________________ to vessel rich tissue

• Rapid __________ and ————-

• No _____________

A

Rapid onset

Rapid redistribution

clearance and metabolism

active metabolites

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5
Q

Properties of an ideal IV induction drug

Pharmacodynamic properties
• _______________ ratio (ratio of ________:____________ dose)

• Minimal ___________ and ————- effects

• No _________________/___________ reactions

A

High therapeutic

toxic dose : minimally effective

cardiovascular and respiratory

histamine release; hypersensitivity

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6
Q

Properties of an ideal IV induction drug

Pharmacodynamic properties
• No _________ effects
• No _____________ movements
• No emergence __________
• No ________ effect
• No ___________ ____________
• Safe to use in ________

A

emetic; involuntary

nightmares; hang over

adrenocortical suppression

porphyria

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7
Q

List 2 ideal Intravenous Anaesthetic agents

A

There is however No ideal Intravenous Anaesthetic agent.

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8
Q

Intravenous anaesthetic agents

Advantages
• rapid and smooth ________ of anaesthesia
• little ________ requirement (syringes, needles, catheters)
•easy _____________ of drugs

A

induction

equipment

administration

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9
Q

Intravenous anaesthetic agents

DisAdvantages

•difficult ________________ once administered
• less control of _________________ of anaesthesia
•lack of ____________ support
•poor tolerability in ________,___________, or ____________ individuals.

A

retrieval of drug

depth and duration

ventilatory

debilitated, dehydrated or toxic

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10
Q

Classification
A. Rapidly Acting (1o) Induction agents
__________

__________

__________ Compounds

__________

A

Barbiturates
Alkyl phenols
Imidazole Compounds
Eugenols

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11
Q

Classification
A. Rapidly Acting (1o) Induction agents
Barbiturates -3
Alkyl phenols-1
Imidazole Compounds-1
Eugenols -1

A

Methohexital
Thiopental Thiamylal

Propofol

Etomidate

Propanidid

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12
Q

__________ rapidly acting (1•) induction agent has been withdrawn from market

A

Propanidid- withdrawn from market

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13
Q

Slower Acting (___________) agents

__________ derivatives
__________
__________

A

basal narcotic

Phencyclidine

Benzodiazepines

Opioids

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14
Q

Slower Acting (basal narcotic) agents

Phencyclidine derivatives
___________

Benzodiazepines
_________ , _________

Opioids
_________, _________, _________, _________

A

Ketamine

Diazepam Midazolam.

Fentanyl Alfentanil Sufentanil morphine

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15
Q

General uses of IV anaesthesia agents

As __________ agents

__________________ (TIVA)
________ Sedation
________ to ________ Anaesthesia ________
________ protection
________ therapy

A

Induction

Total IntraVenous Anaesthesia
ICU Sedation
Supplement ; Regional Anaesthesia Anticonvulsant
Brain protection
Electroconvulsive therapy

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16
Q

TIVA- both ________/_________ of anaesthesia

ICU Sedation: _________,_________

Anticonvulsant: _____,__________

Brain protection: ___________ ( causes reduced ________ )

Electroconvulsive therapy esp. _________ preferred to __________

A

Induction/Maintenance

Propofol,Midazolam

STP, midazolam

Propofol; CMRO2

methohexithal; propofol

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17
Q

Most commonly used iv induction agent is ????

A

Thiopentone

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18
Q

A thiopentone

thio____________

Physical properties:
_______ powder, (soluble or insoluble?) in water with PH of ____, PKa of 7.6 Solution not stable for > ______ after reconstitution in _____ to a 2.5%
Best prepared fresh

A

barbiturate

Yellow ; soluble

10.8 ; 24 hrs

water

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19
Q

A thiopentone

Mode of Action

Act primary at synapses by depressing _____________ to _____________ and inhibit ____________________

A

post-synaptic sensitivity to neurotransmitters

pre-synaptic neurotransmitter release

20
Q

A thiopentone

Administration-

Dose:____ route ____mg/kg
Onset time; _________________ time
DOA: _____________,
Repeated doses effect is ___________
Other route- ________, onset time is within _________

A

iv; 3-7

one arm-brain circulation

5-15 mins

cumulative; rectally; 15 mins

21
Q

Thiopentone

Systemic Effects

CVS- ______ (By ____%), _______ leading to _________tension

Resp. Sys – __________ resp centre, ± ________
Reduces resp centre’s response to _______.

Histamine release may lead to ___________

CNS- _________→ __________ .

Anticonvulsant, ↓_____,_____,______

Skin- ___________ around neck
and chest occasionally

A

↓CO; 20; ↓PVR; hypotension

Depresses; apnoea; CO2

bronchospasm

depressed; hypnosis

CBF, ICP, IOP

erythematous rash

22
Q

Thiopentone

Metabolism
________- main site, @ rate of ______% per hr.

_______% remain in body after 24 hrs.

(Active or Inactive?) metabolites excreted mainly in the ________ , 0.5% excreted unchanged

A

Liver; 10-15

30; Inactive

urine

23
Q

Thiopentone

Contra-indications

Severe __________ or __________
Previous __________
Acute __________ __________
Acute __________ __________

A

Severe hypotension or shock
Previous anaphylaxis
Acute intermittent porphyria
Acute bronchial asthma

24
Q

Thiopentone

Extravascular injection → _________

Inadvertent intra-arterial injection → arterial ______, __________ → __________ of e.g. the hand

Mgt:___________ in the artery, Flush with ________, Inj . _________ to relieve spasm, Keep the hand ______, _______ it, ± anticoagulant therapy

A

severe pain

spasm; thrombosis; gangrene

leave needle; saline

procaine; warm; elevate

25
Q

Ketamine

A ___________ derivative
• Widely used as ________ in developing
countries

Enjoys wider use in _______ because of less post- anaesth effects
Available as ________________- 1%, 5% soln.

A

phencyclidine; TIVA

children

colorless solution

26
Q

Ketamine

Main action- __________ anaesthesia (combination of ___________ with ______________ i.e. _____________). ________,__________ reflexes are preserved

A

Dissociative

profound analgesia with superficial sleep

light hypnosis

Gag, eyelash

27
Q

Ketamine

Administration-

Iv dose-____ mg/Kg, onset time within _____, DOA of ________

im dose-______ mg/Kg, onset time within __________, DOA of ____________

Other routes- ______,_______,_________,__________

A

1-2; 1 min; 5-10 mins

5-10; 5 mins; 10-20 mins

orally, intrathecally, rectally, nasally

28
Q

Ketamine

Systemic Effects
•
– CVS- ____SBP,DBP, ——-PR,→____CO

Resp system- ______ stimulation, with ————- of airway reflexes but _______ still possible. Broncho__________.

CNS- _____ CBF, CMR, IOP. _____ ,______ . State of ________ Anaesthesia.

GIT- _____mucous secretions including salivation, _____ Post-op. nausea and vomiting.

Others- ______ uterine tone.↑ Adr, and Noradr, circ. Levels

A

↑; ↑; ↑

mild; preservation; aspiration; dilatation

↑; Amnesia, Analgesia; Dissociative

↑; ↑; ↑

29
Q

Ketamine

Metabolism- occurs in ______; excreted in ________

A

Liver

Urine

30
Q

Ketamine

Clinical importance-

Good _________ and ________

Potent _________ effect
Can be used as _____ anaesthetic agent, ______ for many surgeries

Anaesthesia in ________,_____________ , LMIC

A

CVS and RS stability

Analgesic; sole; TIVA

war zones ,burn dressing

31
Q

KETAMINE

Disadvantages
•Slower ———— time
•Slower _________
•Poor ___________
•Unpleasant __________,________

A

induction; recovery

muscle relaxation

dreams, hallucinations,

32
Q

emergence delirium from ketamine can be reduced by premedication with _______,_________,__________

A

diazepam, midazolam, lorazepam

33
Q

Ketamine

Contra-indication
•_______tension
•___________ disturbance

A

Hyper

Psychiatric

34
Q

Propofol.
A ________ derivative: 2,6-diisopropylphenol

Presented as _________-in-water emulsion containing
1% (10 mg/ml, common) or 2% propofol in soybean,
purified egg phosphatide, and sodium hydroxide.
No preservative, good culture medium for bacteria

A

phenol

white oil

35
Q

Propofol

The onset of its action begins after ______

After a single dose patient recovers after ________ with a _______ head and _____ hangover.

A

30 s.

5 min

Clear; no hangover

36
Q

Administration of Propofol

•For induction: iv bolus _________ mg/Kg, with onset time of ______, DOA ________ after a single dose

•For maintenance: infusion of _______ mg/Kg/hr

For Children: ↑doses above by _____% for induction, and by _______% for maintenance

A

1.5-2.5

30 secs; 10 mins

4-12 ; 50; 25- 50

37
Q

Propofol

Effects
CVS: ____ BP, ___ SVR→____ CO by ____ %, without ____________ . Attenuates haemodynamic response to laryngoscopy

Rapid bolus injection may cause _________ and __________

RS: ________ with rapid bolus, suppression of ________, depresses ventilatory response to _________,____________ . Broncho_________.

A

↓; ↓; ↓; 20; reflex increase in HR

bradycardia and asystole

apnoea; laryngeal reflexes

hypercarbia and hypoxia

dilatation

38
Q

PROPOFOL

CNS: ______,______ induction with _______ and ————- recovery.
-_____ ICP, CPP, CMRO2, beneficial in __________.

GIT: intrinsic __________ properties

Others- free radical scavenger,
Long term infusion (>48hrs) may lead to _______________ , and ↑ mortality esp. in __________

Causes ——— on injection, may be reduced by Addition of ________, _______ the drug, or use of ____________

A

smooth, rapid

rapid and clear-headed ; ↓; neurosurgery

anti-emetic ; hypertriglyceridaemia

children in ICU; pain; Lidocaine; cooling; large veins

39
Q

Propofol

Metabolism- mainly in ______ to (active or inactive?) __________ + other extra hepatic clearance. Metabolites, and small unchanged form excreted in urine
Renal and Hepatic disease have NO clinically significant effect on metabolism

A

Liver; inactive glucoronide

40
Q

Propofol

Contraindications- ______, untreated __________, ______tension pts

A

Shock

hypovolaemia

hypo

41
Q

Ketofol (mixture of ________ and _________ )

Different concentrations(____,____,____,_____)

Some studies have been done to show efficacy of the combination in procedural sedation.

A

ketamine and propofol

1:1, 1:2, 1:3, 1:4

42
Q

Midazolam

A water (soluble or insoluble?) ________-________

(Mildly or Highly?) protein bound, ______%

Presentation- ________, ________ solution

A

soluble ; Imidazo-benzodiazepine

Highly ; 97%

clear, colorless

43
Q

Midazolam

Main actions
Hypnosis- iv ________
__________
___________
__________ amnesia
Anticonvulsant
___________

A

induction; Sedation

Anxiolysis; Anterograde

Muscular relaxation

44
Q

Midazolam

Administration

_____________/sedation:

im/iv dose :_____ mg/kg _______ pre-induction

Induction dose: iv- ________ mg/kg onset time within ______, DOA _________
Other routes- intrathecal, epidural, oral ( ________/__________)

A

Premedication

0.05-0.1; 30mins

0.2-0.3; 2-3 mins

10-15 mins

sweetened/ flavored

45
Q

Midazolam

Effects
CVS: ____BP,____ SVR, but _______ PR lesser than propofol, thiopentone, hence produces _____________ haemodynamics

RS: impairs respiratory response to ________, respiratory _________, ______ may occur
CNS: ____ CBF, ____ CMRO2→ ____ ICP- brain protection against ischaemia

A

↓; ↓; reflex ; reflex ↑

relatively stable

hypercapnoea; depression; apnoea

↓; ↓; ↓

46
Q

Midazolam

Metabolism- occur in _____, excreted in _______.

-termination of action of single dose is due to _____________ from _______ to ___________

A

Liver; urine

re-distribution

brain ; peripheral tissues

Junior Anaesthesia (17 decks)

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