Module 4-Induction Flashcards
Identify the MAC level when the patient responds to repeated painful stimuli, airway intervention is needed, ventilation possibly inadequate & CV function is maintained
Deep Sedation
Identify the MAC level where the patient responds to verbal/tactile stimulation, no airway intervention needed, ventilation is adequate & CV is usually maintained
Moderate Sedation
Pseudocholinesterase is inhibited by what drugs?
Esmolol, Neostigmine, Regland, in burn patients, renal & liver disease
Sugammadex is effective against
Vecuronium & Rocuronium
What ventilation mode is used with ETT placement?
Volume Control
MOA of Lidocaine
Inactivates Na+ channel & is concentration dependent
Prevents action potential
What is the onset of Succinylcholine?
30 seconds
What is the duration of Succinylcholine?
7-12 min
What is the IV does of Succinylcholine?
1-1.5mg/kg IV
What is the IM does of Succinylcholine?
3-4mg/kg IM
When are the effects of Succinylcholine increased?
When an anticholinesterase reversal is given
How much should you increase Succinylcholine by to give a defasciculating dose?
Increase dose by 1.5-2mg/kg or give NDMR 3-5 min prior
Non-depolarizers MOA
They are competitive antagonists
Prevents initiation of an Action Potential
Intubating dose of Atracurium
0.5mg/kg
Onset of Atracurium
3-5 min
Duration of Atracurium
30-45min
How is Atracurium metabolized?
Ester Hydrolysis
Non-specific plasma esteraase
Hofmann elimination (pH & temp dependent)
Atracurium can cause a
Histamine release
Onset of Mivacurium
3-4min
Mivacurium causes this at low doses
Histamine release
What is the intubating does of Mivacurium?
0.2mg/kg
What is the duration of Mivacurium
15-20min
How is Mivacurium metabolized?
Pseudocholinesterase
Intubating dose of Cis
0.1-0.2mg/kg
What is the onset of Cis
4-7 min
What is the duration of Cis
35-50min
How is Cis metabolized?
Hofmann Elimination
What is the intubating dose of Vecuronium
0.1mg/kg
What is the onset of Vecuronium?
3-4min
What is the duration of Vecuronium
25-50min
Which NDMR is the fastest?
Rocuronium
What is the onset of rocuronium?
1.5-3min
What is the duration of Rocuronium?
30-70min
What is the standard intubating dose of Rocuronium
0.6mg/kg
What is the RSI dose of Rocuronium
1.2mg/kg
What are the vent settings when using an LMA?
VC or PSV
How much Fentanyl can you administer for induction?
100-200mcg
2-3mcg/kg
MAC is a measure of
Potency
Propofol lasts for
10 min
What is the MAC dose of Propofol?
20-100mcg/kg/min
What is the MAC dose of a Ketamine infusion?
0.1-0.3mg/kg/hr
What is the bolus dose of Precedex
0.25-0.75 mcg/kg
% of Ketamine Pro Binding
12%
What is the elimination half life of ketamine?
2-3 hours
Distribution half life of Ketamine
11-17
What is the distribution half life of propofol
2-4
Elimination half life of Propofol
1-5
Pro binding % of Propofol
98
Distribution half life of Etomidate
2-4
Elimination half life of Etomidate
2-5
Pro binding of Etomidate
75
Propofol, Etomidate & Barbiturates cause
An extension of Cl- opening, causing hyperpolarization
What is the percentage makeup of Propofol
10% soybean
2.25% glycerol
1.2% egg lecithin
What makes propofol susceptible to bacterial contamination?
The emulsion
What is in Propofol that can cause an allergy & also prevents bacterial & fungal growth
0.005% disodium edetate
Generic Propofol contains
Sodium Metabisulfite or benzyl alcohol as a preservative
What technique should you use when drawing up propofol?
Aseptic
When should Propofol be discarded?
After 6 hours
Propofol binds to what sub-unit?
Beta 2
With Propofol administration, the influx of Cl- hyper polarizes which synaptic membrane?
The post-synaptic membrane
Propofol is a ______stimulant
Direct stimulant
What causes burning for Propofol
2.25% glycerol
What is the dwelling dose of Lidocaine?
20-40mg
Propofol has what effects?
Antiseizure
Antiemetic
What can help with Propofol burn
Lidocaine
Large bore IV
Why dose Propofol cause cloudy urine?
Uric Acid Crystals
What are the side effects of Etomidate?
Pain on injection
Myoclonia
N/V
Adrenocortical Suppression
There will be a decrease if plasma cortisol for how many hours after Etomidate is given
8-24 hours
What enzyme is inhibited with Etomidate administration
11 beta-hydroxylase
What is the induction dose of Etomidate
0.2-0.3mg/kg
Etomidate will decrease
CRMO2
What do we give with Ketamine & why?
Benzos to help with the dissociative, unpleasant feeling
Ketamine effects on BIS monitoring
Will increase it due to increased cerebral blood flow
What is the onset of Ketamine
30-60sec
What is the duration of Ketamine
10-20min
What is the MOA of Mg+
NMDA antagonist
Which medications can be given for pain control
Mg
Ketamine
Precedex
What is the Ketamine dose for pain
0.25-0.5mg/kg IV
Why is an antisialagogue given with Ketamine?
Because Ketamine causes increased oral secretions
Does Ketamine increase IOP?
Yes, usually at high doses of 6mg/kg, but not with 3mg/kg
Benzos will increase
The Cl- channel opening frequency
What is the onset of Benzos
30-60sec
What is the duration of Benzo
20-60min
Midazolam produces what effects
Anxiolytic
Sedative
Hypnotic
Amnestic
Anticonvulsant
How are Benzos classified?
Elimination half life
Elimination of Diazepam
Greater than 24 hours
Elimination 1/2 time of lorazepam
6-24 hours
Elimination 1/2 time of Midazolam
Less than 6 hours
Benzos provide what type of amnesia?
Anterograde
Is Remimazolam organ independent?
Yes, just like Remifentanil
What makes Remimazolam susceptible to non-specific tissue esterases
Carboxylic ester moiety
Presynaptic effects of Precedex
Sedation
Post synaptic effects of Precedex
CV effects
MOA of Precedex
Negative feedback
Decreases release of NE
Hyperpolarization
What is often seen with Precedex
HOTN
Bradycardia
Precedex resembles
Natural Sleep
Fentanyl MOA
Mu opioid agonist
Celebrex MOA
COX-2 inhibitor
Gabapentin MOA
Blockage of Ca+ voltage gated channels
Acetaminophen MOA
COX 1 & 2 inhibitors
IV onset of Fentanyl
1-2 min
Peak time of Fentanyl
3-5 min
Duration of Fentanyl
30-60 min
Fentanyl goes through
1st pass pulmonary uptake
Scopolamine causes antagonism of
Muscarinic acetylcholine (M1) receptors
Blocks impulse from inner ear to medulla
Apply 2-4 hours pre-stimulus
What are anticholinergic side effects?
Dry mouth, blurred vision, tachycardia, dry skin, rash
How do you treat central anticholinergic syndrome?
Tx with Physostigmine since it crosses the BBB
Tylenol has no effect on
PLTs & has no anti-inflammatory effects
Tylenol can cause
GI bleed, CV events & hepatic toxicity
Celecoxib has the highest risk for
Thrombosis due to COX 2 inhibition
Celecoxib increases the risk for
CV events
Celecoxib decreases the risk of
GI effects
Which 2 neuromuscular blockers are likely to cause anaphylaxis
Succinylcholine
Rocuronium
When does the dose of Sch need to be increased?
When given to an MG patient
Sch has a higher affinity for
Ach
What are some characteristics of Sch (dosage wise)?
Faster onset 30sec
Duration 7-12 min
1-1.5mg/kg IV
Make up of Sch drug
2 Ach molecules are fused together
Competitive agonist of Ach
What complaint is often associated with Sch
Muscle weakness
What complication can potentate Sch
Pseudocholinesterasae deficiency
Sch binds what receptors?
Nicotinic, which blocks Na+ channels from opening & enter the cell
Non depolarizers like Rocuronium are
Competitive antagonist to Ach
Prevent initiation of action potential
What is the onset of Roc
1.5-3min
What is the duration of Roc
30-70min
What is the intubating & RSI dose of Roc
Intubating: 0.6mg/kg
RSI: 1.2mg/kg
Phenylephrine is a
Synthetic non-catecholamine
Phenylephrine mimics
NE effects, but is less potent & last longer
Phenylephrine causes
DIRECT alpha 1 effects
Bradycardia
What is the bolus dose of Phenylephrine
50-200mcg
Esmolol is a selective
Beta 1 antagonist
Characteristics of Esmolol
Decreases SNS response
Short acting
Decreases anesthetic response
Opioid sparing
Masks light anesthesia
What is the bolus dose of Esmolol
0.5-1mg/kg vs 0.2-0.5mg/kg??
How is esmolol metabolized?
Ester hydrolysis in the plasma
When in clindamycin given?
With Ancef allergy
What is the dose of Clindamycin?
600-900 mg Q6H
Clindamycini & NMB
Clindamycin will potentiate the effects of NMB
When is Vanc given?
PNC allergy 10-15mg/kg
MAX 2g
When should vans be infused?
60 min to 2 hours
Ephedrine is an
Indirect acting non catecholamine
Characteristics of Ephedrine
Alpha & beta effects
Increases HR & BP, CO & contractility
When is Ephedrine not effective
Catecholamine depletion
What is the bolus dose of ephedrine?
2.5-10mg bolus
B:G of Sevo
0.65
B:G Des
0.42
B:G Iso
1.46
B:G N2O
0.46
Iso MAC
1.2/1.15
Sevo MAC
2
Des MAC
6
N2O MAC
104
What is MAC awake
The alveolar concentration where patient opens eyes
MAC awake during induction
0.4-0.5
MAC awake during emergence
0.15
MAC bar is the
Alveolar concentration required to block autonomic response following painful stimuli
Movement is prevented in
95% of the population at 1.3 MAC
Awareness & recall are prevented at
0.4-0.5 MAC
MAC bar is equal to
1.5 MAC
What factors increase MAC?
Red head
Chronic ETOH
INcreased CNS NT activity
Increased Na+
Infants 1-6 months
Hyperthermia
What factors decrease MAC
Acute ETOH
Sedation drugs
Hyponatremia
Old age (decreased by 6%/decade after 40)
Extremes of age
Pregnancy
What factors have no effect on MAC
Thyroid issues
Potassium
Gender
Which drugs are metabolized by Pseudocholinesterase
Ester Locals
Succinylcholine
Which drugs are metabolized by non-specific esterases
Remifentanil
Esmolol
Clevidipine
Atracurium
Which drugs are metabolized by Hofmann elimination
Cisatracurium
Atracurium
Flagyl is what type of drug?
Prodrug that causes a concentration gradient
What is the dose of Flagyl
500-1000mg given within 60 min
When should Flagyl be avoided/
ETOH patients
What is the MOA of Vanc
Inhibits cell wall synthesis
Vance can cause what syndrome?
Red man syndrome
