Propofol (brand name)

Induction Dose

Duration (α) half life

Contraindications

Diprovan

2mg/kg

3-8 minutes

Contraindications: hypotension,resp depress, egg/peanut allergy,decreased GFR, Inj Pain. Sulfite brand dependent. Bacterial contamination Propofol Infusion Syndrome

Etomidate (Brand Name)

Induction Dose

Onset -Duration (α) half life

Contraindications

Amidate

0.2 mg/kg

O: <30 seconds

 D: 5-10 minutes

Contraindications: myoclonus, adrenal supression,

injection pain, PONV, Prophyria-Induct: ALA synth

Adrenal supression from blocking of- 11 beta hydroxylase

Ketamine (Brand Name)

Action

 Induction Dose

Duration (α) half life

Onset

Contraindications

Ketalar

NMDA antagonist: Has analgesic properties, bronchodialator

 1-2 mg/kg IV

D 10-20 minutes

O: 10

Contraindications: Emergence reaction, ↑ ocullar, ICP & CBF,PONV, nystagmus,  secretions

Midzolam (Brand Name)

Induction Dose

Duration (α) half life

Contraindications:

Versed

0.3mg/kg

15-30 min

Contraindications: resp depression, ↓ CBF & CMR

Morphine 

Potency

Intraoperative Anesthetic Dose

Duration (Alpha) Half Life

1

0.1-1mg/kg

3-5 hrs

Remifentanil (Brand Name)

Potency

Intraoperative Anesthetic Dose

Duration (Alpha) Half Life

Ultiva

100

1mck/kg

2-5 minutes

Fentanyl(Brand Name)

Potency

Intraoperative Anesthetic Dose

Duration (Alpha) Half Life

Sublimaze

100 

2-150mcg/kg

1-1.5 hrs

Sufentanil(Brand Name)

Potency

Intraoperative Anesthetic Dose

Duration (Alpha) Half Life

Sufenta

1000

0.25-30 mcg/kg

0.8-1.3hrs

Alfentanil(Brand Name)

Potency

Intraoperative Anesthetic Dose

Duration (Alpha) Half Life

Alfenta

20

100-200mcg/kg

20 minutes

Hydromorphone(Brand Name)

Potency

Intraoperative Anesthetic Dose

Duration (Alpha) Half Life

Dilaudid

8

0.03mg/kg

2-3 hrs

Dexmedetomidate (Brand Name)

Class

Receptor

Dose (Loading & Infusion)

Onset

Considerations

Class: Sedative

Receptor: Alpha 2 agonist

Dose

Loading 1mcg/kg over 10min

Infusion 0.3-0.7 mcg/kg/hr

Onset 10min

+analgesia, +neuro cases (decreased NE in brain) brady 

Considerations, inital bolus - transient HTN

Droperidol

Black Box Warning

Anti-emetic? (How and Where)

Class (related Rx)

BB: Can cause QT prolongation → Torsades De Pointes

Dopamine blocker

Butyrophnones

Extrapyramidal side effects

Describe extrapyramidal side effects-

what they are, which drugs can produce them.

bradykinesia, dystonia, tremors, restlessness

Ketamine

 Droperidol

Normeperidine toxic metabolite of demerol

Describe GABA stimulation and the results? 

What ion works on the GABA receptors? 

Stimulation of the GABA receptors has an inhibitory

Cl

HYPERPOLARIZING the post-synaptic neuron 

droperidol

Why does propofol put you to sleep?

Wake you up?

Gaba mimetic

Hyperpolarized cell is inhibited

Cl- Influx causing hyperpolar membrane potential

90-150mv

Wakes you up because it is widley distributed ↑ Vd volume of distribution

Versed is classified as a?

Others

Benzodiazepine

Versed 

induction 0.2-0.4 mg/kg

Diazapam: 0.3-0.6 mg/kg, 20-50hr 1/2 life

Lorazepam: 0.03-0.06 mg/kg 10-16 hr 1/2 ife
  

1-5 hrs

Side effects of etomidate?

Dosage

Administered

Adrenal supression via the 11-hydroxylase

0.3 mg/kg

IV Push for induction

Musclles

order of enterance:

blood, organs, muscle, fat

Propofol

Opiate agonists are?

Endogenous opiate agonists are?

act at opiate receptors

mu,    delta,                         kappa,

                              ↓        ↓                                 ↓

                 enkephalins   beta-endorphin          dynorphins

Analgesia                                                          Constipatio

respiratory depression                                        Rash

sedation                                                            Urinary Retention

euphoria                                                           Tolerance

vasodilation                                                       Dependence  

bradycardia                                                       Itiching 

cough suppression                                             Shivering

miosis  

skeletal muscle rigidity (Fent,Remi,Sufent) 

smooth muscle spasm/biliary spasm

agonism of opiate receptors on the pre-synaptic neurons of target cells decrease the release of substance P.  Substance P does not bind it’s receptors on the post-synaptic neuron, and the nociceptors do not sense pain. 

Decreased RR drive in the CNS

Can cause decreased BP by relaxation or histamine release. 

No Ketamine!

Prop/Etom are good as they decrease CMRO2/ICP

Manitol

Hypervent: to get CO2 to low end of normal

Make sure head is not tilted or constricted, 

Proper analgesia

Demerol

Seretonin Syndrome

Chronic use causes down regulation:

Needing higher dose to produce the same result

Opiates metab

Demerol Metabolism

In liver via Phase 1-2 reactions

Remifent metab'd by Non-Esterase Dependent Hydrolosis

Metab into toxic normeperidine

Morphine 3-5hrs

Hydromorph 1-3hrs

Oxycodone   3.2-4.5hrs

Methadone   15-30hrs

Fentanyl       2-4hrs

Alfentanil      1.5hrs

Remifentanil 9 min

Sufentanil     6hrs

Naloxone      10.8hrs duration 20-60mins

Lipid: Fentanyl, sufentinil, remifentinil, alfentinil

Water : morphine, methadone,

Both: hydromorphone, demerol

Flumazanil 

Mechanaism:

Use:

Lenght of action:

Mech:

benzo antagonist that binds competitively at the benzo site on the GABA receptor inhibiting hyperpolarization

Use: Reversal of benzodiazapines only!

Length of Action:  β half-life is 41-79 minutes

What does GABA stand for? 

Gamma amino butyric acid.

Blocks (antagonism) NMDA (n-methyl d-aspartate) receptors