IV agents

Question 1

In a perfect world, an inductin agent

Answer 1

• Stable in aqueous solution, water soluble
• minimal CV or resp depression
• lack hypersensitivity reactions
• rapid and smooth onset of action
• rapidly metabolized
• produce a steep dose-response relationship
• quick return to baseline mental status

Question 2

PRIS risk factors

Answer 2

• >4mg/kg/hr
• >48hrs
• critical illness
• high fat-low carb intake
• concomitant catecholamine infusion, steroid administration and inborn errors of mitochondrial fatty acid oxidation

Question 3

Signs of PRIS

Answer 3

• CV: hotn, persistent bradycardia refractory to treatment, widening QRS, vtach, vfib, asystole, ischemic EKG, arrythmia, HF
• Resp: hypoxia, pulmonary edema
• Renal: AKI, hyperkalemia
• Muscular: Rhabdo
• Metabolic: fever, High anion gap metabolic acidosis, urine discoloration
• Severe hepatic and renal disturbances, hepatomegaly, abnormal LFT’s, steatosis (fatty liver), lipidemia, hypertryceridemia

Question 4

Which drugs are not affected by hepatic or renal factors?

Answer 4

• midazolam: elimination not altered by renal failure: elimination half-time, Vd and clearance
• Propofol: not influenced by hepatic or renal dysfunction

Question 5

All the 24 & 8 hrs

Answer 5

24 hrs:

• Emergence delirium can occur up to 24 hrs after administration of ketamine
• Precedex TIVA 0.2-0.7 ug/kg/hr up to 24 hrs

8 hrs

• Etomidate adrenocortical suppression lasts greater than 8 hrs