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Anaesthesiology > Module 3b: specific IV anaesthetic agents > Flashcards

Module 3b: specific IV anaesthetic agents Flashcards

1
Q

Give 4 characteristics of propofol?

A
  • 2,6 di-isopropylphenol
  • NOT soluble in water-> prepared as emulsion (soya bean oil, egg yolk + glycerol)
  • Problems with fat emulsion
  • Multiple ampoule sizes: 20ml, 50ml, 100ml OR 1% or 2%
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2
Q

What is the pharmacokinetics of propofol?

A

extremely lipid soluble

crosses BBB easily

extra hepatic metabolism->rapid plasma clearance->rapid emergence

Versatile agent: induction, maintenance, sedation at lower doses

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3
Q

What are the induction dose for adults, elderly and children in propofol

A

Adults: 2-2.5mg/kg
Elderly: 1-1.5mg/kg
Children: 2.5-3mg/kg

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4
Q

CNS effects of propofol?

A

Rapid LOC + recovery
less hangover effect
no excitatory effects
slight analgesic effect

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5
Q

CVS effects of propofol?

A

dose dependent CVS depression

decreased systemic vasc resistance

Decreased BP

Slight increase in HR

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6
Q

Respiratory effects of propofol?

A

dose-dependent depression
apnoea on induction close to 100%
inhibits laryngeal reflexes
NO histamine release

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7
Q

Other effects of propofol?

A

anti-emetic (used in PONV)

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8
Q

What is porpofol infusion syndrome (PRIS)

A

prolonged high dose infusion which presents with lipaemia, metabolic acidosis and myopathy

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9
Q

In which patients should you be careful with giving propofol?

A

Elderly
Cardiac failure
hypovolaemia
Fixed cardiac output: AS/MS, HOCM

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10
Q

In what scenario would propofol be ideal?

A

TIVA Total intravenous anesthesia (TIVA)
Conscious sedation
asthma
porphyria
hx of PONV
hx of malignant hyperthermia

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11
Q

Give the physical properties of thiopentone?

A

yellow powder(mix with H2O or N/saline)
pH 10.5->precipitates with acides
Strength 2.5% (25mg/ml)
Solution stable 24-48hrs

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12
Q

What is the dosage of thiopentone in adults, children and elderly?

A

Adults: 3-5mg/kg
Children: 5-6 mg/kg
Elderly: caution

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13
Q

CNS effects of thiopentone?

A

LOC in 30 sec (used in rapid sequence induction)

Smooth, no reflex movements/coughing

Antanalgesic-> lowers pain threshold

Anti-convulsant

Neuroprotectove: decreased CMRO2 +ICP

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14
Q

CVS effects of thiopentone?

A

Decreased CO (10-20%) by:
Vasodilation, negative inotropy, decreased central catecholamine release

Compensatory increase in HR

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15
Q

Respiratory effects of thiopentone?

A

dose-dependent apnoea
no depression of laryngeal reflexes
histamine release

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16
Q

Other effects of thiopentone

A

irritant to tissues: venous thrombosis with older 5% solutions

Intra-arterial injection precipataes solid crystals-> acute ischemia of limb

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17
Q

What are the contraindication of thiopentone?

A

Absolute: porphyria, known allergy

Relative: asthma, CVS instability(cardiac failure, fixed CO, hypovoloaemia)

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18
Q

Give the physical properties of etomidate?

A

10ml ampoules (2mg/ml=20mg in ampoule)
Clear solution with propylene glycol
Opaque with emulsion

19
Q

What is the dosage in etomidate

A

0.2-0.3mg/kg (adult 16-20mg)

20
Q

Pharmacokinetics of etomidate?

A

rapid recovery: 6-8 min
Repeated doses NOT cumulative

21
Q

True or false: etomidate can be used for induction only

A

True: it causes adrenocortical suppression in infused

22
Q

Etomidate effects on CNS?

A

rapid LOC
Myoclonus and involuntary movements

23
Q

Etomidate effects on CVS?

A

most stable: little change in BP/HR

24
Q

Etomidate effects of resp?

A

minimal resp depression, NO HISTAMINE RELEASE

25
Q

Etomidate effects on GIT?

A

PONV

26
Q

Etomidate effects on endocrine

A

inhibition of steroid synthesis

27
Q

Physical properties of ketamine

A
  • Solutions of 1%(10mg/ml)
  • long shelf half life
  • no pain on injection
  • NMDA receptor antagonist
28
Q

4 characteristics of ketamine?

A

Unusual among induction agents
NMDA receptor antagonist
Causes LOC + analgesic
Given IV, IM or orally

29
Q

CNS effects of ketamine?

A

dissociative anaesthetic
Complete analgesia
Increased ICP and IOP
Psychiatric reactions such as hallucinations

30
Q

CVS effects of ketamine

A

central sympathetic stimulant:
- Increased HR
- Increased BP
- Increased CO
- Increased SVR

31
Q

Respiratory effects of ketamine?

A

minimal respiratory depression
preserved pharyngeal reflexes
maintains airway
bronchodilator (sympathetic stimulation)
Increased salivation

32
Q

Other considerations with ketamine

A

PONV
Uterine contraction in 1st trimester
drug of abuse

33
Q

Indications of ketamine

A

Sick and unstable adults and children
 Burns surgery
 Debridement
 Change of dressings
 Short diagnostic procedures
 Analgesia
 Battlefield anaesthesia
 Status asthmaticus

34
Q

Contra indication of ketamine

A

CVS pathology
 IHD, hypertension, AAA, CCF
 ↑ ICP
 ↑ IOP and “open eye”
 Psychiatric patients
 Epileptics
 Thyrotoxicosis
 Early pregnancy

35
Q

Give the characteristics of benzodiazepines

A

sedative
act on GABA receptor
given as premedication and intra-operative sedation

36
Q

What oral premedications form part of benzodiazepines

A

 Lorazepam, temazepam, diazepam, midazolam

37
Q

What medication forms part of IV sedation

A

midazolam

38
Q

Give the physical properties of midazolam

A

5mg ampoules (1mg/ml) / 15mg ampoules (5mg/ml)

39
Q

What is the dosage for midazolam

A

premed: 0.5mg/kg
Adults 7.5-15 mg
Children 0.25-0.5mg/kg PO

Induction: 0.1-0.3 mg/kg

Sedation 0.1mg/kg

40
Q

CNS effects of midazolam

A

does not occur in one arm-brain circulation time (55-140sec)
anterograde amnesia
anxiolysis
sedation

41
Q

CVS, resp, uterus and git effects of midazolam

A

CVS: stable
resp: little effect
git: low incidence of PONV
Uterus: crosses placenta casuing flopping neonate

42
Q

what is flumazenil

A

benzodiazepine antagonist

43
Q

What is the ideal drug for TIVA

A

propofol

44
Q

What are the indications of TIVA

A

Risk of malignant hyperthermia
– Severe PONV in prior case
– Day-case surgery
– Cheaper than gases

Anaesthesiology (29 decks)

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