IV Anesthetics- Hypnotics Flashcards
Propofol
Class/ category and uses
Class/ Category:GABA agnoist, IV anesthetic, sedative-hypnotic
Uses: Induction, maintenance, sedation, anti-emetic
MOA Propofol
GABA (A) agonist
Propofol
Bolus dose
1.5-2.5 mg/kg, IBW
Propofol
Maintenance infusion
100-200 mcg/kg/min, TBW
Propofol
Sedation Infusion
25-75 mcg/kg/min
Propofol
Onset and Peak
-Onset: 30-60 sec
-Peak: 1.5-2 min
Propofol
Duration and elimination
-Duration: 5-10 min
- Hepatic/ Pulmonary
Propofol
CV effects
-↓ BP(exaggerated in hypovolemia, elderly, and LV dysfunction)
-↓ SVR
-↔/↓ HR
Propofol
Pulm Effects
-↓ RR, ↓ TV
-↓ hypoxia response
-Attenuates bronchoconstriction
Propofol
CNS effects
-↓ CBF, ↓ CMRO2
-↓ ICP
-↓ CPP (cerebral perfusion pressure)
-May produce EEG burst suppression or isoelectric EEG
Can propofol cause myoclonus
YES
T/F propfol caues disinhibition (paradoxical exictation)/ unpredicatble movement
true
Which medication infustion requires tubing changes, how often, use within once primed, and why
Lipid formulation supports bacterial growth – Use within 6 hrs, change tubing every 12 hrs
Two cautions with propofol
-Caution with mitochondrial disease
-Causally associated with soy & egg allergy (specifically yolks)
Does propfol have analgesic effect
minimal to none
T/F propofol triggers MH
False
what is Diprivan
propofol
T/F propfol causes histamine release
False, no histamine release
what is Amidate
Etomidate
Etomidate
Class/ Category and use
-Class/ category: GABA agonist, IV anesthetic
- Use: induction
Mechanism of action of Etomidate
GABA (A) agonist
Etomidate dose and what is it
Bolus: 0.2-0.3 mg/kg
Etomidate
Onset, Peak, Duration
-Onset: 30-60 sec
-Peak: 1-2 mins
-Duration: 5-15 min
Etomidate
Elimination
2!
Hepatic/ plasma cholinesterase
Etomidate
CV Effects
-Minimal to no change HR, CO, SVR, MAP
-May result in sudden ↓ BP if hypovolemic
Etomidate
Pulm effects
↓ Vt, ↑ RR,↓ MV
Etomidate
CNS effects
Hint-5
-↓ CBF, CMRO2
-↓ ICP
-↑/↔ CPP
-Burst suppression possible
-Proconvulsant, lowers seizure threshold
Etomidate
GI effects
PONV
can Etomidate cause myclonus and/or hiccups
yes
Do Etominate and propofol cause pain with injection
yes
Etomidate cautions
-Contraindication: Adrenal suppression
-Avoid if porphyria
-Caution with seizure history, associated with epileptogenic activity
A single dose of Etomidate can cause? what does it inhibit and for up to how long?
Single dose may cause adrenocortical suppression – Inhibits cortisol synthesis (11β-hydroxylase) for up to 72 hrs
Does etomidate release histamine?
Nope
T/F Etomidate has analgesic properties
False, Lacks analgesic properties
What is Ketalar?
Ketamine
Ketamine
class/ category and use
-Class/Category: NMDA antagonist; IV anesthetic; Dissociative anesthetic
-Uses: Pre-medication; Induction, maintenance, analgesia; Sedation
Ketamine
MOA
Non-competitive NMDA antagonist
Ketamine induction dose
Induction Dose: 1-2 mg/kg
Ketamine sedation dose
Sedation dose: 0.2-0.8 mg/kg
Ketamine analgesia dose
Analgesia dose: 0.2-0.5 mg/kg IV
Ketamine
Onest, peak, duration
Onset: 30-60 sec
Peak: 1 min
Duration: 10-20 min
Ketamine
Metabolism
Hepatic
Active metabolite of ketamine
Norketamine (20-33% potency)
Ketamine excretion
Renal (Norketamine), Hepatic (Ketamine)
Ketamine
CV effects
-Typically ↑ HR, BP, CO, SVR
-If endogenous catecholamine deplete or repeat doses, may have a direct myocardial depressant effect (↓ BP & HR), possible CV collapse
-↑ MVO2
Ketamine
Pulm effects
-Bronchodilator
-Airway reflexes slightly depressed or remain intact when used alone; when used at high doses or with other agents, resp depression/apnea possible
-↑ PAP, PVR
Ketamine
CNS effects
6
-↑ CBF, CMRO2 (CBF>CMRO2)
-↑ ICP if not mechanically ventilated
-↑ CPP
-May produce burst suppression at high doses
-Anticonvulsant, unlikely to promote seizure
-Little effect on cerebrovascular autoregulation or PaCO2 responsiveness
Ketamine
GI effects
-N/V
Ketamine causes what to eyes
nystagmus and pupil dilation
How does ketamine effect secretions and what could it cause
↑ secretions: Salivation,may promote laryngospasm
Ketamine emergence reactions
8
- Vivid dreams
- out-of-body experiences
- fear
- hallucinations
- alterations in mood and affect
- delirium
- restlessness
- combativeness
Ketamine Contraindications
5
- Poorly controlled CV disease
- pregnancy
- active psychosis
- severe liver disease
- open globe injury
Ketamine Relative Contraindications
Increased ICP when spontaneously ventilating, increased IOP
Use ketamine causiously with which patient populations
- HTN
- pulm HTN
- increased ICP
- CAD
- severe right heart dysfunction
T/F Avoid ketamine if porphyria
True
Ketamine is MH safe (T/F)
True
Ketamine provides what two pillars of anesthesia
analgesia and amnesia
Ketamine produces what type of state in patients
Dissociative effect produces trance-like cataleptic state
Does ketamine cause histamine release
NO
which drug has highest incidence of PONV for all IV anesthetics ?
Etomidate
Which drug has lowest protein binding, and what is the %
Ketamine, 12%
which drug has the highest volume of distrubution of any induction agent
propofol
what are hypotension predictors in propofol
4
- 50 or older
- baseline DPB<70 mmhg
- ASA III/ IV
- high dose fentanyl co-administration
