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IV Induction Barry

Barry IV Induction Agents

QuestionAnswer
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