Intravenous anesthetics and benzodiazepines

Question 1

Is an IV anesthetic that is a direct myocardial depressant, produces peripheral vasodilation resulting in decreased mean arterial pressure (MAP), and produces a reflex tachycardia.

Answer 1

Sodium thiopental

Question 2

This is an imidazole derivative the induction properties of which result from Gammaamino butyric acid (GABA) receptor modulation. Its side effect include adrenal supression.

Answer 2

Etomidate

Question 3

What to do when you accidentally inject sodium thiopental intra-arterially?

Answer 3

1) Prevent vasospasm (papaverine, procaine or lidocaine)
2) Consider brachial plexus block or a blockade
3) Prevent thrombus formation (heparin)

Question 4

Patients with this allergy should not be administered with thiopental?

Answer 4

Sulfate

Question 5

This IV anesthetic increases porphyrin synthesis and may precipitate an acute porphyria attack with symptoms such as abdominal pain, weakness, autonomic dysfunction, and gastrointestinal and sleep disturbances.

Answer 5

Barbiturates

Question 6

Chemically related to phencyclidine.

Answer 6

Ketamine

Question 7

Decreases serum cortisol levels by blocking two enzymes in the cortisol pathway: 11-b-hydroxylase and 17-a-hydroxylase. Clinically significant adrenal suppression and increased morbidity and mortality have been documented in critically ill patients and septic shock patients.

Answer 7

Etomidate

Question 8

Termination of the effects of intravenous anesthetics is by ______, not biotransformation and breakdown.

Answer 8

Redistribution

Question 9

What population has the highest risk for propofol infusion syndrome.

Answer 9

Critically ill children

Question 10

What conditions increase the risk for propofol infusion syndrome? (3)

Answer 10

1) Exogenous steroids
2) Catecholamines
3) Inadequate carbohydrate intake

Question 11

Manifestation of propofol infusion syndrome? (

Answer 11

1) Cardiac failure
2) Severe metabolic acidosis
3) Rhabdomyolysis
4) Hyperlipidemia
5) Renal failure
6) Death

Question 12

Contents of propofol that may cause allergy?

Answer 12

1) Soy oil

2) Egg lecithin

Question 13

What IV anesthetic has the most cerebral protective profile since it decreases cerebral oxygen consumption (CRMO2) and preserves cerebral perfusion pressure.

Answer 13

Sodium thiopental

Question 14

What GABA subunit does benzodiazepines attach to? How about the GABA?

Answer 14

a

b

Question 15

Is the least lipid soluble benzodiazepine and therefore slowest in onset and longest in duration of action. It also has a long elimination half-life.

Answer 15

Lorazepam