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IV Anesthetics Flashcards

1
Q

What class of drug is propofol?

What important consideration is needed for use of propofol in terms of shelf life?

A

Alkylphenol
With hypnotic properties

*Need to use within 6 hours of drawing it –> always label and date when you draw it

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2
Q

What allergy can you not use propofol?

A

Metabisulfite (component of propofol)

May be present if they have allergies (need allergy testing)

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3
Q

After injection, how much time do you have before patient starts spontaneously breathing and moving again?

A

3-8 min (may be less) –> from redistribution

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4
Q

Induction dose of propofol?

A

1-2.5 mg/kg IV

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5
Q

What is context-sensitive half-life and how does it apply to drug use as infusions?

A

CSHL: elimination T1/2 after a continuous infusion as a function of the duration of the infusion

Shorter the value = recovery is quick

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6
Q

Mechanism of action of propofol?

A

Potentiation of Cl current mediated via GABAa receptor complex

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7
Q

Propofol effect on CNS?

A

Hypnotic
Decreases CBF, CMRO2, ICP
Decreased CPP (MAP - ICP or CVP)
Anticonvulsant

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8
Q

Does propofol provide analgesia?

A

NO

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9
Q

Propofol effect on CV system?

A

Peripheral vasodilation –> decreased BP

You do NOT have reflex tachycardia b/c it blocks the normal baro-reflex response and only have small increase in HR

Can become asystolic

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10
Q

Propofol effect on Resp system?

A

Decreases TV, RR

Can be used in asthmatics

Blunts upper airway reflexes to stimulation

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11
Q

Other unique property of propofol?

A

Anti-emetic

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12
Q

What could be an indicator of propofol infusion syndrome?

A

Unexpected tachycardia –> evaluate for metabolic acidosis

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13
Q

Important consideration before infusion?

A

Pre-med with opioid or lidocaine –> decrease the burn

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14
Q

How does fospropofol work?

A

Prodrug of propofol –> metabolized by ALP that produces propofol, phosphate, formaldehyde

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15
Q

What metabolism do barbiturates undergo?

Considerations?

A

Hepatic oxidation

*drugs that increase or decrease these enzyme activities will affect drug levels

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16
Q

Barbs stimulate what enzyme?

What condition are they C/I in?

A

Aminolevulinic acid (ALA) synthetase

Production of porphyrins is increased

*C/I in acute intermittent porphyria

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17
Q

Barbs effect on CNS?

A 
Decrease CBF (vasoconstrict), CB volume, ICP
Decrease CMRO2
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18
Q

Which barb can induce seizures?

A

Methohexital

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19
Q

Barbs effect on CV system?

A

Dilation of peripheral capacitance vessels –> decreased venous return –> decreased BP and CO

Decrease sympathetic outflow from CNS

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20
Q

Barbs effect on Resp system?

A

Decreased minute ventilation via reduced tidal volume and RR

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21
Q

3 common situations for use?

A

Rapid IV induction
Treat increased ICP
Provide neuroprotection from focal ischemia

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22
Q

Induction doses of thiopental and methohexital?

A

Thiopental: 4 mg/kg IV

Methohexital: 1-1.5 mg/kg IV

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23
Q

What are 2 common combination of drugs for rapid sequence intubation?

A

Barbiturate (thiopental)/ propofol + succinylcholine

Small doses of barbs + face mask with inhaled anesthetic (sevo)

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24
Q

Do barbs provide analgesia?

A

NO

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25
Benzo's MOA?
Activate GABAa receptor complex + enhancement of GABA-mediated Cl currents --> causing hyperpolarization of neurons and decreased excitability
26
4 primary effects of benzo's?
Anxiolysis Sedation Anterograde amnesia Treat seizures
27
Characteristics of benzo's How do they access CNS circulation so rapidly?
Highly lipophilic --> highly bound to serum albumin Acidic benzo preparation contacts the physiologic pH of blood --> changes structure to be more lipid soluble --> speeds its passage across BBB
28
Benzo's effect on CNS? CV?
Decrease CMRO2, CBF Peripheral vasodilation
29
Benzo's effect on Resp?
Decrease ventilatory response to CO2 Most severe Resp depression occurs when given with opioids
30
Reversal of benzo's?
Flumazenil
31
Dosage of midazolam (premed) in adults? Children?
Adults: 1-2mg IV Children: 0.5 mg/kg given ORALLY 30 min BEFORE induction of anesthesia
32
What class of drug is commonly coax ministered with benzo's for induction?
Opioids (fentanyl 50-100 mcg IV) *Given 1-3 minutes BEFORE benzo is given
33
Class of drug for ketamine? MOA?
PCP derivative MOA: inhibits NMDA receptor complex Very lipid soluble --> rapid onset of drug effects Low protein binding
34
Does ketamine provide analgesia?
YES - analgesia with minimal respiratory depression!
35
Metabolism of ketamine?
CYP450
36
What is main concern with giving ketamine? How to prevent it?
Dissociative amnesia --> patient's eyes are open w/ slow nystagmus gaze / also have vivid dreams *Unpleasant emergence reactions (dreams, hallucinations, etc) Prevent with benzo!
37
Other side effect of ketamine? Prevention?
Lacrimation and salivation increased Pretreat with anti-ACh
38
Effect of ketamine on CNS? When do you NOT want to use it?
Cerebral vasodilator --> increases CBF, CMRO2 NOT used in people with increased ICP
39
Explain ketamine's effect on seizures?
May produce myoclonus, but NOT seizures --> actually an anti-convulsive
40
Ketamine effect on CV?
Central stimulation of SNS - increase BP, HR, CO Can be blunted by benzo's, opioids, inhalation agents It is myocardial depressant (direct) --> masked by (+) of SNS
41
Ketamine effects on Resp?
As single drug, Resp response to hypercapnia is preserved Bronchodilation --> good with reactive airway disease
42
Why is there increased risk of laryngospasm with ketamine?
Increases salivation
43
Overall 4 benefits of ketamine use?
Profound analgesia Stimulation of sympathetic nervous system Bronchodilation Minimal respiratory depression
44
What 2 conditions is ketamine useful?
Uncooperative peds patients | Mentally challenged
45
Induction dosage of ketamine?
1-2 mg/kg IV | 4-6 mg/kg IM
46
Class of drug for Etomidate? MOA?
Imidazole GABA-like effects via potentiation of GABAa-mediated Cl currents
47
How is etomidate metabolized? How does this effect dosing?
Ester hydrolysis Duration of action is linearly related to the dose
48
Etomidate effects on CNS?
Cerebral vasoconstrictor --> decreased CBF, ICP Cause myoclonus MAY potentiation seizures
49
Etomidate effects on CV system?
Very stable --> minimal decrease in SVR (more exaggerated in hypovolemia) *minimal changes in HR and CO Ideal drug for induction of CV risk patients
50
Endocrine effects of etomidate?
Adrenocortical suppression --> inhibits 11B-hydroxylase (no cortisol) Lasts for 4-8 hours after induction dose
51
Clinical uses of etomidate?
Alternative to propofol and barbs for rapid IV induction of anesthesia --> esp w/compromised myocardial contractility
52
Induction dose of etomidate?
0.2-0.3 mg/kg IV
53
Does etomidate provide analgesia?
NO
54
2 side effects after etomidate administration?
1) Myoclonus movements (NOT seizures) --> can mask these with use of NM blockers 2) PONV may be more common
55
MOA of dexmedetomidine (Precedex) Metabolism?
a2-agonist in locus ceruleus - Hypnosis from LC a2 (+) - Analgesia at level of spinal cord Imidazole derivative Rapid hepatic metabolism
56
How is context sensitive half life in Precedex?
Sig increase from 4 min after 10-min infusion to 250min after 8hr infusion
57
CV effects of Precedex? Bolus vs infusion?
Decreased HR, SVR (and consequently BP) Heart block can occur from unopposed vagal stimulation --> use anti-ACh Bolus: transient increase in systemic BP and decreases the HR (peripheral a2 receptors) Infusion: unopposed vagal (+) and bradycardia
58
Clinical uses of Precedex?
Sedation of trachea-incubated pts in ICU Sedation during awake or regional anesthesia
59
Initial and infusion doses of Precedex?
Initial: 0.5-1.0 mcg/kg over 10-15 min Infusion: 0.2-0.7 mcg/kg/hr
60
Benefit of Precedex with awakening patient?
Provides sedation + analgesia without respiratory depression | Blunts laryngeal sensitivity without knocking them out
61
If patient starts to wake up during MAC/TIVA, what is the best approach for maintaining anesthesia?
1) Give a bolus of IV anesthetic 2) Increase the rate of infusion *Bolus can be given via pump/infuser

Anesthesia (10 decks)

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