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Anesthesia > IV Anesthetics > Flashcards

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
Q

Benzo’s MOA?

A

Activate GABAa receptor complex + enhancement of GABA-mediated Cl currents –> causing hyperpolarization of neurons and decreased excitability

26
Q

4 primary effects of benzo’s?

A

Anxiolysis
Sedation
Anterograde amnesia
Treat seizures

27
Q

Characteristics of benzo’s

How do they access CNS circulation so rapidly?

A

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
Q

Benzo’s effect on CNS?

CV?

A

Decrease CMRO2, CBF

Peripheral vasodilation

29
Q

Benzo’s effect on Resp?

A

Decrease ventilatory response to CO2

Most severe Resp depression occurs when given with opioids

30
Q

Reversal of benzo’s?

A

Flumazenil

31
Q

Dosage of midazolam (premed) in adults? Children?

A

Adults: 1-2mg IV
Children: 0.5 mg/kg given ORALLY 30 min BEFORE induction of anesthesia

32
Q

What class of drug is commonly coax ministered with benzo’s for induction?

A

Opioids (fentanyl 50-100 mcg IV)

*Given 1-3 minutes BEFORE benzo is given

33
Q

Class of drug for ketamine?

MOA?

A

PCP derivative

MOA: inhibits NMDA receptor complex
Very lipid soluble –> rapid onset of drug effects
Low protein binding

34
Q

Does ketamine provide analgesia?

A

YES - analgesia with minimal respiratory depression!

35
Q

Metabolism of ketamine?

A

CYP450

36
Q

What is main concern with giving ketamine?

How to prevent it?

A

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
Q

Other side effect of ketamine?

Prevention?

A

Lacrimation and salivation increased

Pretreat with anti-ACh

38
Q

Effect of ketamine on CNS?

When do you NOT want to use it?

A

Cerebral vasodilator –> increases CBF, CMRO2

NOT used in people with increased ICP

39
Q

Explain ketamine’s effect on seizures?

A

May produce myoclonus, but NOT seizures –> actually an anti-convulsive

40
Q

Ketamine effect on CV?

A

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
Q

Ketamine effects on Resp?

A

As single drug, Resp response to hypercapnia is preserved

Bronchodilation –> good with reactive airway disease

42
Q

Why is there increased risk of laryngospasm with ketamine?

A

Increases salivation

43
Q

Overall 4 benefits of ketamine use?

A

Profound analgesia
Stimulation of sympathetic nervous system
Bronchodilation
Minimal respiratory depression

44
Q

What 2 conditions is ketamine useful?

A

Uncooperative peds patients

Mentally challenged

45
Q

Induction dosage of ketamine?

A

1-2 mg/kg IV

4-6 mg/kg IM

46
Q

Class of drug for Etomidate?

MOA?

A

Imidazole

GABA-like effects via potentiation of GABAa-mediated Cl currents

47
Q

How is etomidate metabolized?

How does this effect dosing?

A

Ester hydrolysis

Duration of action is linearly related to the dose

48
Q

Etomidate effects on CNS?

A

Cerebral vasoconstrictor –> decreased CBF, ICP

Cause myoclonus

MAY potentiation seizures

49
Q

Etomidate effects on CV system?

A

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
Q

Endocrine effects of etomidate?

A

Adrenocortical suppression –> inhibits 11B-hydroxylase (no cortisol)

Lasts for 4-8 hours after induction dose

51
Q

Clinical uses of etomidate?

A

Alternative to propofol and barbs for rapid IV induction of anesthesia –> esp w/compromised myocardial contractility

52
Q

Induction dose of etomidate?

A

0.2-0.3 mg/kg IV

53
Q

Does etomidate provide analgesia?

A

NO

54
Q

2 side effects after etomidate administration?

A

1) Myoclonus movements (NOT seizures) –> can mask these with use of NM blockers
2) PONV may be more common

55
Q

MOA of dexmedetomidine (Precedex)

Metabolism?

A

a2-agonist in locus ceruleus

  • Hypnosis from LC a2 (+)
  • Analgesia at level of spinal cord

Imidazole derivative

Rapid hepatic metabolism

56
Q

How is context sensitive half life in Precedex?

A

Sig increase from 4 min after 10-min infusion to 250min after 8hr infusion

57
Q

CV effects of Precedex?

Bolus vs infusion?

A

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
Q

Clinical uses of Precedex?

A

Sedation of trachea-incubated pts in ICU

Sedation during awake or regional anesthesia

59
Q

Initial and infusion doses of Precedex?

A

Initial: 0.5-1.0 mcg/kg over 10-15 min

Infusion: 0.2-0.7 mcg/kg/hr

60
Q

Benefit of Precedex with awakening patient?

A

Provides sedation + analgesia without respiratory depression

Blunts laryngeal sensitivity without knocking them out

61
Q

If patient starts to wake up during MAC/TIVA, what is the best approach for maintaining anesthesia?

A

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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