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27 Cards in this Set
- Front
- Back
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Induction Agents |
Given to obtund sensorium Quick onset, brief duration Laryngeal reflexes lost No analgesia |
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Hypnotics (Barbiturates) |
Indications for use: anesthetic induction, sedation, MAC, maintenance of anesthesia
Commonly used: sodium thiopental (Pentothal), methohexital (Brevital) |
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Barbiturates Overview |
-Cause myocardial suppression -Cause respiratory depression due to increased sensitivity to CO2 levels leading to apnea -Depth of respiration is depressed more than rate -Laryngospasm due to laryngeal reflexes not depressed until deep anesthesia is reached |
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thiopental |
Pentothal Penetrates all body tissues Become unconscious quickly Recovery may be prolonged if induction dose was excessive Rapid/pleasant induction No antagonist available |
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methohexital |
Brevital Ultrashort acting, quick induction & recovery; amnesic effects, no analgesia
Same degree of CV and resp depression as thiopental
Lowers seizure threshold
Burns on IV administration |
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etomidate (card 1) |
Amidate Non-Barbiturate induction agent Agent of choice in CV patients Onset: 15-45 seconds Duration: 3-12 minutes HR and CO remain constant Increased risk of N&V Potent hypnotic Less respiratory depression than thiopental |
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etomidate (card 2) |
Amidate -Decreases cerebral blood flow and cerebral oxygen consumption without decreasing BP: great for neuro patients -May have dose related reduction of TV and rate (apnea) -Laryngospasm, cough, hiccups may occur but are less with use of opiates
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diprivan (card 1) |
Propofol Rapid onset and emergence Onset: 15-45 seconds Duration: 5-10 minutes No analgesia No cululative effects Less N&V Dose dependent resp and circ depression |
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diprivan (card 2) |
-Non-bargiturate hypnotic -Midazalom acts synergistacally: may reduce propofol by 50% -Emergence is raid -Decreases cerebral perfusion, cerebral blood flow and ICP -IV push or continuous drip |
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ketamine (card 1) |
Onset: 15-45 seconds Duration: 3-12 minutes Produces excellent analgesia Produces sisassociative anesthesia -no recollection of surgery -appears to be awake -minimal respiratory depression |
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ketamine (card 2) |
-Disassociative agent -Selectively blocks pain conduction & perception -Produces profound state of analgesia & unconsciousness -Respiratory function unimpaired -Protective reflexes intact -Increases HR, BP, & CO -Potential for increased secreation -Increases cerberal blood flow -Potential for emergence delirium |
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Benzodiazepines |
-Pre-med for surgery -Anesthetic adjunct -Sedation during local & regional anesthesia -Post-op anxiety & agitation -Therapeutic effects: calming, sedation, hynosis, amnesia, supression of seizure activity -diazepam (Valium), midazolam (Versed), lorazepam (Ativan) -Antagonist/reversal: flumazenil (Romazicon) |
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diazepam |
Valium -Premed, adjunct, induction agent -Amnesia up to 48 hours -Long half life (20-48 hours) -Resp depression increases with opiates -Muscle relaxant properties -Useful for psychomotor & petit mal seizures -Painful injection: IM or IV |
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midazolam |
Versed -Premed, adjunct to inhalation, induction agent -Hypnotic, anticonvulsant, muscle relaxant -3x as potent as diazepam -Decrease BP, SVR -Increase in HR -Half life (2-6 hours) -Use with caution in MI, COPD -No effect in ICP |
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lorazepam |
Ativan -Long acting -Slow onset: 20-40 minutes -Duration: may last 24 hours -Profound amnesia, reduction of anxiety -Good CV & respiratory stability |
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Opioids |
Indications for use: sedation, analgesia, induction & maintneance of general anesthesia, regional anesthesia, moderate sedation & analgesia, post-op pain management Commonly used: morphine, fentanly, sufentanil, alfentanil, remifentanil, hydromophone |
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morphine sulfate |
Onset: <1 minute Peak: 20 minutes Duration: 1 - 4 hours Dose: 1 - 10mg titrated Myocardial function is preserved Causes histaine release Slight hypotension |
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fentanyl citrate |
Sublimaze Onset: 1-3 minutes Duration: 30-60 minutes Dose: 0.05-2 mcg/kg titrated Watch for apnea and chest wall rigidity When released from tissue may have delayed respiratory depression |
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hydromorphone |
Dilaudid Onset: 3-5 minutes Duration: 3-4 hours 7x mor potent than morphine Good in renal insufficiency Not for increased ICP or decreased resp function |
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naloxone |
Narcan Rapid reversal of opiods only! Onset: 1-2 minutes Duration: dependent on dose and route Dilute 0.4mg with 9ml NS (0.04mg/ml)
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Inhalation Agents General Facts |
-Used to produce unconsciousness & amnesia -No residual analgesia -Disribution directly proportional to blood flow of each region -Elimination primarily pulmonary -Gaseous inhalation anesthetic -Nitrous oxide -Volatile Inhalation anesthetic -Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane |
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halothane |
-Sweet, non-irritating -Great bronchodilator -Agent of choice for mask inductions & peds -Less likely to cause laryngospasm -Greatest degree of respiratory depression -MH trigger |
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enflurane |
Ethrane -Irritating odor -Most likely to display lingering effects in PACU -Vasodilator: may be used for intentional HoTN -Little effect on HR -Hemodynamically more stable than Halothane |
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isoflurane |
Forane -Strong pungent odor -May cause breath holding and laryngospasm -Stabilizing effect on CV system -Excellent muscle relaxant -No CNS excitatory effects -Increases HR w/o compromising CO -Strong pungent odor -Potentiates neuromuscular blockade -Rarely toxic |
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desflurane |
Suprane -Strong pungent odor -Fast onset, emergence -High incidence of laryngospasm -Eliminated primarily by exhalation as an intact molecule
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sevoflurane |
Ultane -Minimal airway irritation, better w/ kids -MH trigger -No analgesia -Hypotension, dysrhythmias, respiratory depression -Potentiates neuromuscular blockade -Low solubility = rapid onset & recovery
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nitrous oxide |
-Separate class - gaseous inhalation agent -Odorless to sweet smelling -Reduces amount of volatile agents -Minimal muscle relaxant properties -Very good analgesia effects -Increased PONV -Not MH trigger |
