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Anestetics One
General Anestetic IV Agents
6
Medical
Professional
04/01/2013

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Term
Thiopental (barbituates)
Definition
General IV anestetic (not common US) that comes as a sodium salt, pH>10.

PRECIPITATES IN ACID ENV.
THROMBOEMBOLIC ARTERIAL COMPLICATIONS

Gaba-A agonist that activates cl-
rapidlly redistributes from brain

prolonged hangover from slow hepatic metabolism (except phenobarbital)

CONTRAINDICATED PORPHRIA

rapid onset, hypotension with reflex tachycardia. Isoelectric EEG. sometimes used as an anticonvulsant
Term
Benzodiazepines (anesthesia)
Definition
not typically from IV but used as a pre-op anxiolytic

LORAZEPAM = RETROGRADE Amnesia long activing by glucuronidation

Midzalam = short active anterograde by microsomal oxidation

Binds gamma subunit GABA-R.

Variable onset by type, mild drop in BP, no change HR/RR

drops CMRO --> iso EEG
Term
Propofol
Definition
agent of choice IV anestesia with rapid onset and repid redistribution

EGG YOLK EMULSION MAY GRO BACTERIA

directly activates gaba-r
HAS HIGH PLASMA CLEARANCE --> NO HANGOVER

rapid hepatic met to inactive then excreted kidney

SIGNIFIGANT HYPO-T (V and A) + APNEA
Isoelectric EEG + pain on injection

REDUCES POST OP NAUSEA/VOMITING

(remember drops everything)
Term
Etomidate
Definition
hemodynamically stabile general anestetic with little analgesia

comes in a PEG mixture

metabolism by PLASMA ESTER HYDROLASE = slight hangover

moderate respiratory depression but NO DELTA BP/HR = HEART PATIENT or BLEEDING

EXCITATORY EEG!!! (avoid seizure ppl)

increase POST OP NAUSEA/VOMIT and
steroid supression of 11-b-hydroxylase
Term
Ketamine
Definition
rapid dissociative amnesia (not hypnosis)

ANTAGONISM NMDA RECEPTOR

low protein binding and h2o soluble

N-demethylation to active metabolite in LIVER

1. unpleasant nightmares/re-emergence (not as likely children)
2. CMRO2 increasese = CONTRA-INDICATED TUMORS but decreaes seizures

SIGNIFIGANT NYSTAGMUS/SALVATION/LACRIMATION

INCREASES HR/BP/CBF from NorE stimulaton
Term
Monitored anestesia care (MAC)
vs
SAC
Definition
Monitored requires presence of anesthesiologist
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