Prop, Etom, Keta Flashcards
Dose for induction using propofol
1-2.5 mg/kg
2,6 - di-isopropylphenol can also be found in __
Perfumes and laundry detergents
Propofol chemical class
Alkyl phenol
What induction drug has the most rapid and complete awakening?
Propofol
Propofol half time
0.5 - 1.5 hours
Does cirrhosis or end stage renal or old age affect the elimination of prop?
No
Prop __ cross placenta
Can
But is rapidly cleared from fetal circulation
Does propofol support growth of bacteria?
Yes - E. coli and pseudomonas
Peds dose for prop induction
2.5-3.5 mg/kg
Due to larger central distribution and greater clearance
How does propofol work?
GABA receptors –> influx chlorine –> hyper polarization
Why not due inhalation induction on everyone?
Skip stage two with IV induction
Elderly need 25-50% smaller prop dose due to
Smaller central distribution volumes and decreased clearance
Prop conscious sedation dose in Mcg/kg/min
25-300 mcg/kg/min
Dose for PONV using prop
10-15 mg, followed by a 10 mcg/kg/min infusion
Prop dose for pruritus of neuroaxial opioids
10mg
Prop has anti-convulsant properties due to __
GABA mediated pre and post synaptic inhibition
4 things propofol does to brain
Decreases cerebral metabolic o2 requirements, cerebral blood flow, and ICP
Anticonvulsant - anti seizure
Can have uncommon induction convulsion but not seizures rt spontaneous excitatory movt of sub cortical origin
Prop __ change evoked potentials
Does NOT
Prop inhibits sympathetic vasoconstrictor nerve activity causing __
Decreased BP
Increase worsening of bp drop with using propofol with what factors?
Hypovolemia (dehydration)
Elderly
Dec LV fx
Aortic stenosis
Prop may have negative inotropic effects due to __
Decreased intracellular Ca++
Can you rapidly change your des while on prop and not have a CV response?
Unfortunately not
Should you give prop to a child with “googlie eyes” undergoing strabismus surg?
Be careful, can increase oculocardiac reflex causing bradycardia or arrest
Props effects on lungs of asthmatics
Bronchodilation
Reduces wheezes
Does prop mess with your kidneys or liver fx
No
Prolonged prop infusions cause green urine due to excreted __ and cloudy urine from __ acid excretion
Green urine - excreted phenols
Cloudy urine - uric acid excretion
Effects of propofol on ventilation
Vent depression - even worse w opioids
Dec TV and rr
Dec co2/hypoxia response
Bronchodilator
Prop __ IOP from induction to intubation
Lowers
Talk to me about prop allergy
Patients with prior exposure to di-isopropyl (perfumes/detergents/fabric softener/ skin preps)
Multiple other allergies
NMB allergies
Soy
Egg whites
The most common adverse effect of prop
How can we help that?
Pain on injection
Lidocaine & opioids
Larger bore IV
Etomidate chemical structure
Carboxylated imidazole ring
Imidazole ring is __ soluble at acid pH and __ soluble at physiologic pH
Water
Lipid
Etom mech of action
Enhances effects of GABA
Just like prop
Etom Vd is __ due to large tissue uptake
Large
Etom pKa
4.2
Etom peak brain levels _ minute after admin
1 min
Etomidate and protein binding
Etom is 76% protein bound, thus decrease in hypo blood protein leads to increase circulating etomidate
Prompt awakening for etom due to __
Redistribution
Etom half time __
2-5 hours
Induction dose of etom
0.2-0.4 mg/kg
How to prevent shake and bake with etom
Effects of etom on epilepsy
Give opioids and benzodiazepines
Etomidate can cause excitatory spikes and myoclonus/tremors, but can also break status epilepticus
Use w caution in epileptics
Etom has __ analgesic properties
No
Etom and ECTs?
Preferable to thiopental and propofol
Etom __ PONV
Increases incidence
Etom and icp…
Decreases cerebral metabolic o2 (35-45%) requirements and ICPs
Increase cerebral vasoconstriction
Etom and epileptic patients?
Cautiously
Dose dependent
Double edged, can also terminate status epilepticus
Etom __ IOP
Lowers
Accidental intra-arterial etom injection
“OK”
Etom can make your patient breathe like a _ on a hot rock
Lizard
Dec TV in rr
Go for spon breathing pt
Can cause apnea
Etom causes adrenocortical suppression
Inhibition of what enzyme? It’s job?
Time frame of inhibition?
Special consideration populations–
via inhibition of conversion of cholesterol to cortisol via enzyme
11-beta-hydroxylase
Enzyme inhibitions lasts 4-8 hrs
so use cautiously with septic and bleeders
Ketamine drug class
Phencyclidine derivative
PCP structurally similar James Brown, hog tranquilizer
Ketamine acts on a lot of receptors EXCEPT __
GABA
Ketamine peaks in 1 minute and is __ significantly bound to plasma proteins
NOT
__ is the active metabolite of ketamine
Norketamine
Ketamine in the neuro room?
No
Which antisialagogue for ketamine and why?
Glyco because atropine and scop cross BBB and increase delirium
Ketamine induction dose
1-2 mg/kg IV
4-8 mg/kg IM
Ketamine retains laryngeal and pharyngeal reflexes
True
Ketamine- consciousness returns in __ minutes and baseline in __
10-20 mins
60-90 mins
Ketamine and CAD?
No, increases myocardial O2 needs
Ketamine and catecholamine depleted patients?
No
Ketamine and asthma and MH?
Yes
Ketamine and systemic HTN, pulm HTN, inc ICP, eye cases?
No
Ketamine inc cerebral blood flow so __ must be employed
Hyperventilation
Mechanism of CV effects with ketamine?
Inc SNS outflow = inc plasma catecholamine levels
Ketamine relaxes airways and has no __ release or __ reactions
Histamine
Allergic
Ketamine _ mac
Reduces
Ketamine __ NMBs
enhances
Ketamine and cortical blindness
Depression of inferior colliculus and medial geniculate nucleus
Ketamine and emergence delirium
Increased with female patients older than 15 with a hx of psych illness and doses greater than 2mg/kg
Give versed 5 mins before
Is etomidate painful on injection like propofol?
Yes
Why is etomidate drug of choice for CV pts?
Minimal neg inotrope effects
Cardiovascular stability .3mg/kg or more dosing
