sedation Flashcards
What 3 classes of drugs used for sedation?
- muscle relaxant - relax vocal chords to prevent spasms
- Opiod pain mx
- Induction agent
Thiopental - induction
- Extremely rapid onset of action making it the agent of choice for rapid sequence of induction
What side effects
- Marked myocardial depression may occur
- Metabolites build up quickly
- Unsuitable for maintenance infusion
- Little analgesic effects
Propofol - induction
- fast onset
2. Widely used especially for maintaining sedation on ITU, total IV anaesthesia and for daycase surgery
Propofol - SE
- Rapidly metabolised with little accumulation of metabolites
- Proven anti emetic properties
- Moderate myocardial depression
Ketamine - induction
- NMDA receptor antagonist
2. May be used for induction of anaesthesia
Ketamine - SE
- Has moderate to strong analgesic properties
- Produces little myocardial depression making it a suitable agent for anaesthesia in those who are haemodynamically unstable
- May induce state of dissociative anaesthesia resulting in nightmares
Etomidate - SE
- Has favorable cardiac safety profile with very little haemodynamic instability
- No analgesic properties
- Unsuitable for maintaining sedation as prolonged (and even brief) use may result in adrenal suppression
- Post operative vomiting is common
What is an induction agent?
a drug used to get a patient to sleep
What side effects are caused by both Thiopentone and Propofol
- Airway - reduced airway reflexes
- Breathing - respiratory depression
- Cardiovascular - vasodilation
- Disability - unconsciousness
What are main side effects of Thiopentone?
- reduced cardiac output / marked myocardial depression my occur
- Risk of severe anaphylaxis
What are the main side effects of Propofol?
- Antiemetic effects
2. Hyperlipidaemia
what are inhalation anaesthetic agents used for?
used following induction to maintain anaesthesia
Name 2 commonly used inhalation agents?
- Sevoflurane
2. Nitrous oxide
What is nitrous oxide used for?
analgesia properties are more potent than anaesthetic properties
What are the main contraindications to nitrous oxide use?
nitrous oxide can escape the blood and accumulate in potential air sacs in the body
- pneumothorax
- air embolus
- Skull fracture - air filled pocked could increase ICP
- Intestinal obstruction
why is nitrous oxide use contraindicated in pregnancy?
inactivates vitamin B12 which is an important co factor of DNA synthesis
