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IV Induction Barry
Barry IV Induction Agents
| Question | Answer |
|---|---|
| What are the overall mechanisms of action(3) of the barbiturates? | Depresses the reticular activating system, enhances the inhibition of GABA, and inhibits the transmission of excitatory neurotransmitters such as acetylcholine. |
| What is the reticular activating sytem responsible for? | Maintenance of wakefulness |
| What is the most common inhibitory neurotransmitter in the brain? | GABA |
| What is the most common excitatory and overall neurotransmitter in the brain? | Glutamate |
| What are some of the characteristics of IV induction agents? | Rapid induction of anesthesia, usually highly lipophilic, rapid onset of action, rapid recovery due to redistribution. |
| What makes thiopental so highly lipid soluble? | The addition of a sulfur group |
| What is the resulting percentage solution after Thiopental is reconstituted? | 2.5%, which is 25mg/ml. |
| What is the induction dose of Thiopental? | 3-5 mg/kg IV |
| What is the reconstituted solution and how many mg/ml is Methohexital? | 1%, which is 10mg/ml |
| Which IV anesthetics should you not give to a patient with a history of seizures? | Etomidate and Methohexital |
| What is the IV induction dose of Methohexital? | 1-2 mg/kg IV |
| What is the rectal dose of Methohexital? | 25 mg/kg of a 10% solution |
| How do the benzodiazepines work? | Enhance the inhibitory effects of GABA. |
| What are the benzodiazepines used for? | Sedation, amnesia, anxiolysis, and anticonvulsants. |
| Why are Diazepam/lorazapam/etomidate painful when given IV or IM? | It is mixed with propylene glycol because it is insoluble in water. |
| What is a problem with Diazepam? | It undergoes metabolism to an active metabolite. |
| What is the preop IV sedation dose of Diazepam? | 0.02-0.04 mg/kg IV |
| What are some benefits of giving Midazolam instead of Diazepam? | Elimination half time is 1-4 hrs vs that of valium which is 21-37 hrs, NO active metabolites, and causes less cardiac depression than valium. |
| What is a great benefit of giving Versed? | It causes anterograde amnesia |
| What is the IV Midazolam dose for sedation? | 0.01- 0.1 mg/kg IV for sedation |
| What is the IV Midazolam dose for induction? | 0.1-0.2 mg/kg IV for induction in cardiac patients |
| What are some benefits of giving Midazolam instead of Diazepam? | Elimination half time is 1-4 hrs vs that of valium which is 21-37 hrs, NO active metabolites, and causes less cardiac depression than valium. |
| What is a great benefit of giving Versed? | It causes anterograde amnesia |
| What is the IV Midazolam dose for sedation? | 0.01- 0.1 mg/kg IV for sedation |
| What is the IV Midazolam dose for induction? | 0.1-0.2 mg/kg IV for induction (Usually only used in cardiac patients for induction) |
| What is Etomidate's mechanism of action? | Produces CNS depression primarily by enhancing effects of GABA. |
| What are some potential problems that may occur due to the administration of Etomidate? | May activate seizure foci, may temporarily cause adrenal suppression, and has a high incidence of myoclonus. |
| What is a benefit of administering Etomidate? | Minimal effects on CV system |
| What is the recommended IV induction dose of Etomidate? | 0.2-0.3 mg/kg for induction |
| What is the mechanism of action of Ketamine? | Does not depress the CNS but causes "dissociation” of the thalamus from the limbic system and is thought to inhibit NMDA receptor complex (glutamte receptor) |
| What is the IV induction dose of Ketamine? | 1-2 mg/kg IV induction. |
| What is the IM pre-op or procedural dose of Ketamine? | 3-5mg/kg IM |
| How does the patient that has been given Ketamine present? | Pt appears conscious but cannot process sensory input, they have roving eye movements, skeletal muscle movement and hallucinations. |
| What are the benefits of administration of Ketamine? | Produces excellent analgesia, no respiratory depression, and bronchial smooth muscle relaxation. |
| What are the side effects caused by the administration of Ketamine? | Increased salivation, HR, CO, BP, ICP* and emergence delerium. |
| What is the structure of propofol and how is it thought to work? | It is a isopropyl phenol and is thought to work on GABA. |
| What is the IV induction dose of Propofol? | 1.5-2.5 mg/kg IV induction |
| What are the infusion doses of Propofol for sedation and maintenance? | 25-100 mcq’s/kg/min for sedation 100-300 mcq’s/kg/min for maintenance |
| In how many hours must a opened vial of Propofol be used in? | Within six hours. |
| What are a couple of side effects of Propofol that are useful? | Antiemetic and antipuretic |
| What is the mechanism of action of Precedex? | It's primary action is via activation of CNS post-synaptic alpha 2 receptors to inhibit the release of norepinephrine. |
| What are the expected effects seen in a patient given Precedex? | Results in decreased SNS output, anxiolysis, sedation, and analgesia. no respiratory depression and reduces MAC and opioid requirements. |
| What are the loading and maintenance doses of Precedex? | Loading dose: 0.5-1mcq/kg over 10-20 min Maintenance: 0.2-0.7 mcq/kg/hr |
| What is the Diazepam pre-op sedation dose PO? | 0.2-0.5mg/kg PO |
| propofol contains the following(which may cause allergic reactions): | soybean oil and egg lecithin (from egg yolks) |
| A problematic respiratory side effect of thiopental is: | bronchospasm |
Created by:
Ieshaz
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