Term
|
Definition
-Long and Intermediate acting (phenobarbital, pentobarbital, secobarbital)
-Short acting (thiopental)
-Ultra short acting (methohexital) |
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Term
|
Definition
-Depression of reticular activating system (maintenance of wakefulness)
-Facilitates Inhibitory (GABA) transmitters
-Decreases sympathetic nerve transmission (decrease SVR– BP) |
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Term
| Barbiturates (CV effects) |
|
Definition
-Decrease in BP with Compensatory baroreceptor-mediated increase in HR
-Peripheral vasodilation secondary to decreased sympathetic outflow
-Peripheral vasodilation—pooling of blood– decrease venous return—decrease Cardiac output (hypovolemic patient) |
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Term
| Barbiturates (Resp. effects) |
|
Definition
-Depress medullary ventilatory centers producing apnea at clinical doses
-Larnylgeal and cough reflexes are minimally depressed at clinical doses |
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Term
| Barbiturates (CNS effects) |
|
Definition
-Potent cerebral vasoconstrictors
-Decrease cerebral blood flow,blood volume, and intracranial pressure (ICP)
-Decreases cerebral metabolic oxygen requirements(CMRO2)
-Decreases EEG activity (Antiseizure effect) exception—methohexital activates epileptic foci (ECT)
-May provide protection during regional cerebral ischemia but not global ischemia |
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Term
| Barbiturates (Pharmacokinetics) |
|
Definition
-Cerebral uptake within 30-60seconds (IV)
-Rapid awakening due to Redistibution to inactive tissues (muscle and fat)
-Large Volume of Distribution
-Hepatic metabolism and renal excretion
-Elimination depends on metabolism—only 1% cleared by kidneys (mostly hepatic not renal) |
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Term
| Barbiturates (Clinical uses) |
|
Definition
-Induction of anesthesia (unconscious 30 sec)
-Thiopental 3-5mg/kg Methohexital 1-1.5
-Elimination half-time Th-11hrs, M-4hrs
-Decreases ICP “brain protection”
-Rectally—Facilitates induction of anesthesia in uncooperative patients |
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Term
| Benzodiazepines (general) |
|
Definition
-Large number in clinical use
-Midazolam (Versed)
-Lorazepam (Ativan)
-Diazepam (Valium)
-Diazepam—new formulation---old solvent propylene glycol caused pain on injection |
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Term
| Benzodiazepines (Pharmacological effects) |
|
Definition
-Sedation “calming”
-Anterograde amnesia (minimal retrograde)
-Anticonvulsant |
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Term
| Benzodiazepines (Clinical uses) |
|
Definition
-CV —minimal depression
-RESP----minimal ventilatory depression
-Antagonist----Flumazenil |
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Term
|
Definition
-Enhance chloride channel gating function of GABA (inhibitory neurotransmitter)
-Receptors on post-synaptic nerve endings in CNS---greatest density in cerebral cortex |
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Term
| Benzodiazepines (Pharmacokinetics) |
|
Definition
-Highly lipid soluble with rapid uptake in CNS
-Hepatic metabolism
-Diazepam– active metabolites—prolonged effects
-Midazolam– no active metabolites |
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Term
| Benzodiazepines (Clinical uses) |
|
Definition
-Preoperative medication (Diaz 5-10mg, Midaz 1-3mg)
-Intravenous Sedation
-Induction of anesthesia (Midaz 0.1-0.3mg/kg)
-Anticonvulsant (Diaz 10mg, Midaz 3-5mg) |
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Term
|
Definition
-Isopropylphenol
-Oil in water emulsion (“milk”)
-Contains soybean oil, gycerol, egg lecithin (Allergic Potential)
-Antiemetic effect
-Pain on Injection“burning”– treat-Lidocaine
-Disodium Edetate—retards rate of bacterial growth but
-Can support growth
(12 hr limit on infusions, 6 hr after open single vial) |
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Term
|
Definition
-Rapid induction of anesthesia –CNS
-Unconscious in less than 30 seconds (2-2.5mg/kg)
-Rapid redistribution and awakening with minimal residual CNS effects (4-8minutes)
-Excellent for Outpatient surgery****** |
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Term
|
Definition
-Decrease in blood pressure with minimal increase in HR (can be more pronounced than thiopental)
-Peripheral Vasodilation –Pooling of blood- decreased venous return—Potential for decreased Cardiac Output (hypovolemic pt.) |
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Term
|
Definition
-Depresses meduallary ventilatory centers producing apnea (usually 1-2 minutes at 2-2.5mg/kg)
-Laryngeal reflexes minimally depressed |
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Term
| Propofol (Pharmacokinetics) |
|
Definition
-Rapid redistribution to inactive tissue sites
-Hepatic metabolism to inactive metabolites
-Renal Elimination |
|
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Term
|
Definition
-Induction of anesthesia-Unconscious<30sec
-Dose 2-2.5 mg /kg (can complete IV without use of inhalational agent)
-Maintenance of anesthesia—continuous infusion at 100mcg-200mcg/kg
-IV sedation 25-50mcg/kg (usually in addition to regional or local anesthesia) |
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Term
|
Definition
-Carboxilated Imidazole
-Rapid Induction of anesthesia (Unconscious < 30sec)
-Pharmacologically inactive metabolites |
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Term
| Etomidate (CV/Resp. effects) |
|
Definition
-CV Stability -> Minimal effects on BP, HR, and CO (***good for patient with heart disease or other heart issues***)
-Produces apnea with minimal effects on laryngeal reflexes |
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Term
|
Definition
-Decreases cerebral blood flow, CMRO2,and ICP
-Can activate seizure foci like methohexital |
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Term
| Etomidate (Pharmacokinetics) |
|
Definition
-Fairly rapid redistribution to inactive sites
-Hepatic Elimination |
|
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Term
| Etomidate (clinical uses) |
|
Definition
-Induction of anesthesia 0.2-0.3mg/kg
-Especially patients with limited cardiac reserve |
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Term
| Etomidate (disadvantages/adverse effects) |
|
Definition
-Pain on injection (propylene glycol)
-Involuntary skeletal muscle movements (myotonic activity -> may look like seizure activity))
-Increased incidence of post-op N/V
-Adrenocortical suppression Up to 8hrs after induction dose |
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Term
|
Definition
-Phencyclidine derivative
-Produces dissociative anesthesia between thalmus and limbic system |
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Term
|
Definition
-Direct stimulation of sympathetic nervious system (release of catecholamines)
-HR, BP and CO maintained even in hypovolemic patients |
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Term
| Ketamine (Pharmacokinetics) |
|
Definition
-Rapid onset-high lipid solubility
-IV-within 60sec 1-2mg/kg
-Rapid redistribution to inactive sites
-Hepatic metabolism |
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Term
|
Definition
-Induction of anesthesia (1-2mg/kg IV, 5-10mg/kg IM)
-Dissociative anesthesia (analgesia) small doses 10-40mg (dressing change-burn patient)
-***Useful in patients with multiple trauma and/or severe hemorrhage----CV effects***
-Analgesia greater for Somatic pain than Viceral pain |
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Term
| Ketamine (disadvantages/adverse effects) |
|
Definition
-Emergence Delirium 30%
-Vivid hallucinations (nightmares) during reawakening and recovery---minimized with benzodiazepine use
-Development of tolerance with repeat doses
-Increased airway secretions—Increased risk laryngospasm (may close off vocal cords and reduce breathing) |
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