Properties of an Ideal Intravenous Induction Agent

Question 1

Regarding induction agents (true or false):\

Etomidate-lipuro reduces the incidence of pain on injection

Answer 1

True

Question 2

Regarding induction agents (true or false):

Propofol has advantages for patients with a significant history of post-operative nausea and vomiting

Answer 2

True

Question 3

Regarding induction agents (true or false):

Etomidate has the lowest incidence of hypersensitivity reactions among the intravenous induction agents

Answer 3

True

Question 4

Regarding induction agents (true or false):

Changes in protein binding due to hepatic impairment has no significant effect on the dose of induction agent required

Answer 4

False. Reduced protein binding with a lower albumin concentration may significantly increase the free fraction and therefore the effect of the dose administered.

Question 5

Regarding induction agents (true or false):

The reduction in the induction dose required in the elderly is due to changes in cardiovascular function

Answer 5

False. The reduction in induction dose required is due to increased sensitivity.

Question 6

Regarding induction agents (true or false):

Thiopental has the sulphur atom on the barbituric acid ring which increases speed of onset

Answer 6

True

Question 7

Regarding induction agents (true or false):

The advantages of propofol in day care is due to the rapid clearance

Answer 7

True

Question 8

Regarding induction agents (true or false):

Emergence phenomena following ketamine can be avoided by premedication with benzodiazepines

Answer 8

False. Emergence phenomena can be reduced by benzodiazepine premedication but not avoided.

Question 9

Regarding induction agents (true or false):

The infrequent use of Etomidate in day care surgery is related to its pharmacokinetics

Answer 9

False. Etomidate is not used frequently due to pain on injection, involuntary movements and increased emesis compared with other agents.

Question 10

Regarding induction agents (true or false):

Thiopental undergoes tautomeric change following injection into the plasma

Answer 10

True

Question 11

Regarding induction agents (true or false):

Thiopental is recommended for use in rapid sequence induction as it has the highest therapeutic index

Answer 11

False. Thiopental has a low therapeutic index though may be used for rapid sequence induction due to rapid onset.

Question 12

Regarding induction agents (true or false):

Etomidate can be used for an infusion in the critically ill as it has a high therapeutic index with minimal effect on the myocardium

Answer 12

False. Etomidate by infusion is contraindicated due to impaired steroid metabolism.

Question 13

Regarding induction agents (true or false):

Ketamine can be used on intensive care for treatment of bronchospasm

Answer 13

True

Question 14

Regarding induction agents (true or false):

Since ketamine maintains arterial pressure it may safely be used in trauma associated with intracranial injury

Answer 14

True. Ketamine is believed to raise intracranial pressure but cardiovascular stability and improved oxygen delivery in intracranial injury outweigh this theoretical disadvantage.

Question 15

Regarding induction agents (true or false):

Propofol will result in a reduction in arterial blood pressure due to dose dependent myocardial depression and vasodilatation

Answer 15

True

Question 16

Which one of the following statements best describes the presentation of thiopental?

A. As 500 mg for mixing with 10 ml water
B. As a solution of 5% thiopental
C. As a powder containing 6% anhydrous sodium carbonate
D. When dissolved results in a solution of pH 4
E. The ampoule contains thiopental powder in air and is stable and has a long shelf-life prior to mixing

Answer 16

C. The powder contains 6% anhydrous sodium carbonate

500 mg thiopental is mixed with 20ml water
This produces a 2.5% solution
The pH of this solution is approximately 10.5
The ampoule contains nitrogen gas