Term
| Which three injectable anesthetics are CIII? |
|
Definition
-Thiopental
-Ketamine
-Tiletamine (Telazol) |
|
|
Term
| List the other injectable anesthetics that are scheduled? |
|
Definition
-Propofol
-Etomidate
-Opioid-benzo combos |
|
|
Term
| In dogs, which inj. anesth has a TI of 3950? |
|
Definition
|
|
Term
| Describe how to prepare Thiopental |
|
Definition
-Pentothal
-powder, reconstitute (2.5 and 5 % solutions)
-pale yellow, alkaline solution
-precipitates when mixed with most other drugs |
|
|
Term
| What should you do if Thiopental turns in to a lye solution? |
|
Definition
-dilute!
-at least 5 X the injected volume
-prevent: use IV catheters, read labels |
|
|
Term
| Describe how to prepare Etomidate. |
|
Definition
-0.2 % solution (2 mg/ml)
-solubilized in propylene glycol (35%)
(high osmoloality)
-clear
-carrier may cause hemolysis |
|
|
Term
| Describe how to prepare Propofol. |
|
Definition
-insoluble in water!
-prepared in lipid emulsion
-supports bacterial growth (handle aseptically)
-no preservative (short shelf life: 4-24 hours) |
|
|
Term
| Describe how to prepare Ketamine. |
|
Definition
-soluble in water
-10% solution (100 mg/ml)
-well absorbed (IM) |
|
|
Term
| Describe how to prepare Tiletamine. |
|
Definition
-Lypholized powder
-100 mg/ml when reconstituted
(50 mg/ml tletamine, 50 mg/ml zolazepam)
-short shelf life
-very well absorbed IM |
|
|
Term
| What factors can affect recovery? |
|
Definition
-other drugs given
-inhalant maintenance
-pain
-body temperature |
|
|
Term
| Benefits/drawbacks of using Etomidate for induction. |
|
Definition
-great for sick or old patients
-best with premeds or paired with benzo (minimize risk of myoclonus)
-pain (related to propylene glycol?)
-retching and vomiting (as lose consciousness) |
|
|
Term
| Benefits/drawbacks of using Propofol for induction. |
|
Definition
-very smooth (excitement free, slower onset of effect, administer slowly)
-Apnea common (dose and rate related, e prepared to intubate/ventilate)
-cyanosis is also common
-muscle ridgidity |
|
|
Term
| Benefits/drawbacks of using Ketamine for induction. |
|
Definition
-ketamine alone is undesirable
-almost always give w/ benzo or other drugs
-retain many reflexes
-jaw tone, swallowing make intubation more challengin
-depth interpretation is more complicated
-diazepam/ketamine is very popular, and does work well once familiar with it |
|
|
Term
| Summary of induction qualities of common drugs. |
|
Definition
-thiopental (alkaline, must go IV, smooth and reliable)
-Etomidate (propylene glycol, hemolysis; best reserved for sick or old)
-Propofol (lipid emulsion, bacterial growth; smooth and reliable)
-Ketamine (effective IM or IV, stings; widest safety margin and use) |
|
|
Term
| What factors can affect recovery? |
|
Definition
-other drugs given
-inhalant maintenance
-pain
-body temperature |
|
|
Term
|
Definition
-well documented problems with thiobarbituate anesthesia (prolonged, rough recoveries)
-initially thought to be due to lack of fat for redistribution
-has been shown that they enzyme deficiency that slows metabolism |
|
|
Term
|
Definition
-rapid (occasionally prolonged in debilitated patients)
-may be rough w/o premeds on board
-rapidly metabolized, so recovery rapid regardless of multiple doses or CRI |
|
|
Term
|
Definition
-ketamine alone is undesirable
-as commonly used, with other drugs, gives acceptable recoveries
-Telazol may be slow (following IM dose, in occasional cat-Flumazenil) |
|
|
Term
| Propfol:Thiopental mixture. |
|
Definition
-first reported use in humans
-synergism
-recovery quality similar to propofol
-reduce cost
-drug stability
-inhibit bacterial growth
-less apnea, less hypotention? |
|
|
Term
| Clinical use of Propofol: Thiopental |
|
Definition
-mix in the same syringe (propofol: 1/2 of "propofol only" calculated dose; Thiopental (2.5%): same volume as propofol)
-mix into sterile vial: measure volume of propofol using a sterile syringe, add same volume of thiopental (2.5%), solution contains 5 mg/ml Propofol, 12.4 mg/ml Thiopental |
|
|
Term
| Recovery qualities of Thiopental. |
|
Definition
-smooth, unless too short
-BAD in greyhounds |
|
|
Term
| Recovery qualities of Etomidate. |
|
Definition
-fast
-can be rough if going "commando" (no premeds) |
|
|
Term
| Recovery qualities of Propofol. |
|
Definition
-smooth and reliable
-combine with thio to reduce cost, inhibit bacterial growth |
|
|
Term
| Recovery qualities of Ketamine. |
|
Definition
-acceptable (can be a lot of movement)
-unpredictably prolonged in cats with tiletamine-zolazepam |
|
|
Term
|
Definition
-Thiopental and etomidate-rapid equilibration of BB concentration (15-30 sec)
-Propofol-slower; results in slower onset of effects (30-60 sec)
-Ketamine-traditionally given more slowly |
|
|
Term
| Cerebral blood flow, metabolic oxygen consumption, CSF pressure |
|
Definition
-Thiopental, propofol, etomidate (decrease metabolic rate, decrease CO2 production, decrease O2 consumption, and decrease intracranial pressure)
-Thiopental, propofol, etomidate ("cerebral protectinon")
-Ketamine-opposite! |
|
|
Term
| Anesthetics and the seizuring patient |
|
Definition
-ultimate therapy for seizuring patient-> anesthesia
-Thiopental, propofol-> effective anticonvulsants
-Etomidate, propofol-> may produce myoclonic activity (controversial)
-Katemine-> contraindicated in patients at risk? |
|
|
Term
| Analgesia: thiopental, propofol, etomidate |
|
Definition
-NOT analgesic
-hyperalgesia at low doses?
-but how can we do painful things with these injectables? |
|
|
Term
|
Definition
-NMDA recptor antagonist
-Analgesic |
|
|
Term
| Other qualities of common drugs (NEED TO KNOW) |
|
Definition
-Thiopental-cerebroprotective, anticonvulants, NO analgesia
-Etomidate-Cerebroprotective, anticonvulsant, NO analgesia
-Propofol-Cerebroprotective, anticonvulsant (or, maybe not??), no analgesia
-Ketamine-NOT cerebroprotective (or is it??), analgesia!!! (somatic > visceral) |
|
|
Term
| Etomidate: Cardiovascular effects. |
|
Definition
-nothing changes
-drug of choice for cardiovascularly compromised patient |
|
|
Term
|
Definition
-healthy patient: transient tachycardia, little effect on CO/BP
-unpremedicated patient: arrhythmias common, VPC's bigeminy
-compromised patient: significant hypotension |
|
|
Term
|
Definition
-moderately hypotention (vasodilation, transient)
-may be pronounced in compromised patient
-tendency for bradycardia
-not arrhthmogenic |
|
|
Term
|
Definition
-increased: HR, Contractility, CO, BP
-usually good
-but: also increase myocardial O2 consumption, workload
-may not be well tolerated in some CV disease states
-due to increased CNS sympathetic outflow, increased endogenous CA |
|
|
Term
| Respiratory effects of Ketamine/Etomidate |
|
Definition
-mild effect on ventilation
-will decrease ventilatory response to hypercapnia (modestly) |
|
|
Term
| Respiratory effects of Thiopental/propofol |
|
Definition
-cetnrally-mediated resp depression
-apnea (if occurs, what do we do?)
-cyanosis |
|
|
Term
|
Definition
-ketamine produces bronchodilation (useful for asthmatics?)
-Propofol: implicated in bronchoconstriction (but, might produce bronchodilation-patient dependent????) |
|
|
Term
| CP effects of common drugs (what need to know) |
|
Definition
-Thiopental-increased HR, arrythmogenic (venricular bigeminy), apnea
-Propofol-decreased HR, VASODILATION, apnea
-Etomidate-NO CHANGE IN HR, NO CHANGE IN RR
-Ketamine-sympathomimetic effects, bronchodilation |
|
|
Term
| Hepatic effects of injectable anesthetics. |
|
Definition
-maintenance of CO, BP, of most importance
-drug metabolism
-protein binding
-patient with liver dz (propofol, etomidate?; inhalant, opiod) |
|
|
Term
| Renal disease associated with injectable anesthetics. |
|
Definition
-maintenance of CO, BP of most importance
(preoperative stabilization, CV monitoring, aggressive therapy of hypotension)
-cats and ketamine
-hemolysis and etomidate |
|
|
Term
| Endocrine effects of injectable anesthetics. |
|
Definition
-depresses adrenocortical function
-single dose (not an issue)
-multiple doses/long term CRI
(significant issues, increase morbidity, increase mortality) |
|
|
Term
| Ophthalmological effects of injectable anesthetics. |
|
Definition
-intraocular pressure (may be a concern with deep corneal ulcers, penetrating wounds to eye)
-Ketamine: increased pressure (not a good choice; remember, eye=brain)
-others: decrease pressure |
|
|
Term
| Price of injectable anesthetics |
|
Definition
-thiopental
-diazepam/ketamine(least expensive)
-propofol (moderately expensive)
-Etomidate (wicked expensive) |
|
|
Term
| Criteria to consider when deciding on injectable anesthetic: |
|
Definition
-procedure: analgesia needed? expected duration?
-patient personality: calm? hyperactive? aggressive?
-patient status: neonate, elderly or ill=more profound effect? |
|
|
Term
| General rules of thumb for inj anesthetics in dogs. |
|
Definition
-good, reliable sedation from opioids (remember not all opioids are the same)
-can augment sedation, by adding: major tranq, minor tranq (benzo), sedative (A2agonist)
-lost of choices for induction (depends on patient and premed results (if used) |
|
|
Term
| General rules of thumb for inj anesthetics: cats |
|
Definition
-NOT reliable sedation from opioids
-for chemical restrain, you need ONE Of 3 (dissociative, A2agonist, Chamber ("box) induction with inhalant
-lots of choices for induction (depends on patient and premed results -if used) |
|
|
