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IV Anesthetics Flashcards

1
Q

How quickly must you use Propofol after opening?

A

6 hrs (due to emulsion amendable to bacterial growth)

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2
Q

Describe propofol metabolism

A

Rapid liver metabolism, inactive compound excreted by kidney

clearance > hepatic blood flow = extrahepatic metabolism

~30% metabolized in lungs

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3
Q

Typical wake up time after propofol bolus?

A

8-10 min (DOA 3-8 min)

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4
Q

Rapidity of wake up from propofol likely 2/2 what?

A

redistribution from highly perfused (brain) to poorly perfused (fat/muscle) tissues

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5
Q

Induction dose of propofol

A

1-2.5 mg/kg IV

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6
Q

Protein binding % of propofol

A

97%

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7
Q

MOA of propofol

A

increase chloride current via GABAa receptor

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8
Q

Major CNS effects of propofol?

A
  • hypnotic
  • decrease CBF/CMRO2/ICP/IOP

NOT AN ANALGESIC

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9
Q

CV effects of propofol (HR, SVR)

A

Large decrease in MAP via vasodilation (arteries and veins)

Decrease preload and afterload

Inhibits baroreflex = only small increase in HR

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10
Q

Respiratory effects of Propofol (RR, Vt, CO2/O2 response)

A

Induction dose = Respiratory depressant, apnea

Maintenance dose = reduce minute ventlation (decrease RR and Vt)

blunt CO2/O2 vent response

reduce upper airway responsiveness (less laryngospasm)

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11
Q

post-surgical benefit of propofol

A

anti-emetic

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12
Q

Pt with unexpected tachycardia during propofol anesthesia…what should you look for?

A

Labs- BMP

metabolic acidosis possible (propofol infusion syndrome)

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13
Q

How can you reduce injection pain with propofol?

A
  1. pre-medicate with opioid
  2. co-administer with lidocaine (50-100mg IV)
  3. Dilution
  4. use larger veins
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14
Q

What factors would decrease the required induction dose of propofol?

A

old age

pre-med with opioids/benzos

reduced CV reserve

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15
Q

What factors increase the required induction dose of propofol?

A

age (children need upwards of 2.5-3.5mg/kg IV)

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16
Q

Continuous propofol infusion rate for maintenance of anesthesia

A

100-200ug/kg/min (if combined with NO or opioids for analgesia)

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17
Q

Continuous propofol infusion rate for sedation

A

25-75 ug/kg/min

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18
Q

anti-emetic dosing of propofol

A

10-20mg IV

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19
Q

Difference between propofol and fospropofol

A

fospropofol (Lusedra) = water-solubule pro drug of propofol used for MAC

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20
Q

biproducts of fospropofol

A

propofol + phosphate + formaldehyde

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21
Q

difference between propofol and fospropofol duration

A

fospropofol = longer onset/ofset duration (due to prodrug form)

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22
Q

Major barbiturates used in IV induction

A

thiopental

methohexital

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23
Q

Major effects of barbiturates in anesthesia

A

hyponotic

sedative/general anesthetic

anticonvulsant

NOT AN ANALGESIC

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24
Q

Downfall of barbiturates (thopental/methohexital) re: solution

A

alkaline Na salt w/ pH > 10 –> precipitation with injected with acidic drugs (like neuromuscular blocking drugs)

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25
Metabolism of barbiturates exception?
hepatic metabolism via oxidation and N-dealkylation/desulfaration exception = phenobarbital (renal excretion)
26
clearance of methohexital vs thiopental?
methohexital = more rapid than thiopental (quicker duration of action)
27
MOA of barbiturates
enhancement of inhibitor neurotransmiter (GABAa) inhibition of excitatory transmission (unclear specific target)
28
Major CNS effects of barbiturate
Cerebral vasoconstric Decrase CBF Decrease ICP Decrease CMRO2 = Flat line EEG (except methohexital = increase epileptic foci) GREAT FOR USE IN SPACE OCCUPYING IC LESIONS
29
CV effects of barbiturates
Decrease BP (vasodilate, decrease sympathetic outflow) compensatory increase in HR (blunt hypotension) Decrease CO 2/2 decrease VR (pooling of blood in capacitance vessels)
30
Which patients will have exagerated CV response to barbiturates?
- hypovolemia - cardiac tamponade - cardiomyopathy - CAD - cardiac valve disease (** can't compensate for decreased SVR with increased CO)
31
Respiratory effects of barbiturates
- resp depressant = decreased minute vent (decreased Vt and RR) decrease vent response to CO2/O2 LESS reduction in upper airway response (don't use without NM blockers for DL)
32
Major side effects of barbiturates
1. arterial injection = pain, tissue damage from vasoconstriction 2. sub-cut injection = pain/local tissue irritation USE DILUTE PREPS! (2.5% thiopental, 1% methohexital)
33
Induction dose of thiopental
3-5mg/kg IV
34
Induction dose of methohexital
1-1.5mg/kg IV
35
Benzos commonly used in anesthesia
diazepam, midazolam, lorazepam
36
Desired effects of benzos
anterograde amnesia anxiolysis = GREAT PREMEDICATION Also- anti-epileptic
37
quickest onset benzo? why?
midazolam (versed) most lipid soluble (rapid distribution to brain, then redistribution to inactive tissue sites)
38
MOA of benzos
activate GABAa, increase Cl current, hyperpolarize neuron, reduce excitability most in cerebral cortex, post-synaptic nerve endings minimal effects outside CNS
39
most potent benzo
Midazolam = higher affinity for benzo receptor (x2 diazepam)
40
CNS effects of benzos
decrease CBF and CMRO2 (less than barbs and propofol though) ceiling effect not neuroprotective like barbs
41
CV effects of benzos
minimal decrease in BP (Midazolam>diazepam) worse in volume depleted patients
42
Resp effects of benzos
minimal vent depression...increased with opioids
43
Clinical uses of benzos
1. preop medication 2. IV sedation 3. IV induction of anesthesia 4. suppress seizure activity
44
Versed dosing for premedication (IV)
1-2mg IV
45
PO premedication dosing of Versed in peds
0.5mg/kg PO 30 min before induction
46
Induction dose Versed
0.1-0.3mg/kg IV facilitate with small dose opioid (fentanyl 50-100ug IV) 1-3 min pre benzo dosing
47
Major desired effect of Ketamine
ANALGESIA dissociative anesthesia
48
Ketamine onset, ofset
rapid, high lipid solubility rapid, redistribution to inactive tissue
49
protein binding of ketamine
low 12% (unique)
50
Major MOA of ketamine
inhibition of NMDA receptor
51
Side effects of katamine
- open eyes, dilated, nystagmus | - lacrimation/salvation increased (premedicate with anticholinergic)
52
How can you diminish emergence reactions with ketamine?
benzos less reactions in kids
53
CNS effects of ketamine
Vasodilate cerebral vessesls = increase CBF Increase CMRO2 DO NOT USE IN PATIENTS IWTH INCREASED ICP/INTRACRANIAL PATH
54
CV effects of Ketamine blunt them how?
significant/transient increase in BP, HR, CO 2/2 sympathetic outflow increase blunt w/ opioids, benzos, inhaled anesthetics
55
Why may ketamine be a poor choice in critically ill patient?
Direct myocardial depressant critically ill = decreased ability to increase sympathetic output = blunt increase bp/hr/co = cardiogenic shock issues
56
Respiratory effects of ketamine
No significant resp depression large bolus doses can cause transient hypovent/short apnea bronchodilation = good for asthma laryngospasm possible = increased salivation (DON'T ASSUME AIRWAY IS PROTECTED)
57
Induction dose Ketamine
1-2mg/kg IV 4-6mg/kg IM
58
Maintenance dose Ketamine
Alone - 30-90ug/kg/min IV With 50-70% NO - 15-45ug/kg/min IV
59
Analgesic dose ketamine
0.2-0.8mg/kg IV
60
Etomidate effects
hyponotic NO ANALGESIA
61
Typical concentration of etomidate
2mg/ml solution
62
Major metabolism site of etomidate
serum esterase, excreated into urine/bile
63
Relative duration of etomidate
Dose dependent, linear 100sec unconsciousness per 0.1mg/kg given
64
MOA of etomidate
GABA like effects, potentiate GABAa receptor effects
65
CNS effects of etomidate
potent cerebral vasoconstrictor decrease CBF and ICP NOT NEUROPROTECTIVE
66
CV effects of etomidate
CV stability after bolus injection BP decrease modest/absent hypovolemia = some decrease in SVR Minimal change in HR or cardiac contractility
67
resp effects of etomidate
resp depressant (less than barbiturates) apnea (after bolus doses ) possible increased resp effects w/ opioids/inhaled anesthetics
68
worrisome side effect of etomidate
adrenocortical suppression (dose dependent inhibition of AaB-hydroxylase) lasts 4-8 hrs after induction dose
69
Induction dose of Etomidate
0.2-0.3mg/kg IV
70
What is dexmedetomidine?
highly selective alpha-2 blocker
71
Context sensitive half time of dexmedetomidine?
Significant increase w/ dose 10 min after 4 min inffusion 250min after 8hr infusion
72
MOA of dexmedetomidine?
hyponosis from stim of alpha-2 in locus ceruleus analgesia from SC level
73
CNS effectts of dexmedetomidine?
decrease CBF no signifcant change in ICP or CMRO2
74
CV effects of dexmedetomidine
- moderate decrease in HR and SVR Bolus dose = transient increase in SVR, decrease HR (peripheral activation of alpha-2)
75
respiratory changes of dexmedetomidine
- small decrease in Vt | - no change in RR
76
Major uses of dexmedetomidine?
1. short term sedation for intubated/ventilated patients (ICU) 2. adjunct to general anesthesia 3. sedation for awake fiberoptic intubation 4. in conjunction with regional anesthesia
77
Dexmedetomidine dosing
0.5-1ug/kg IV (initial over 10-15 min) + infusion 0.2-0.7 ug/kg/hr

Anesthesia (9 decks)

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