Barbiturates

Methohexital (Brevital®)

Thiamylal (Surital®)

Thiopental (Pentothal®)

Methohexital

Brevital®

Metabolism: Hydroxylation at CH₂ α to triple bond

Crosses the blood brain barrier, Ultrashort duration

Barbiturate

Thiamylal

Surital®

Ultrashort duration (≈ 30 minutes)

Barbiturate

Thiopental

Pentothal®

MOA: Enhancement of GABA-A binding of GABA & diminish AMPA activity

"Thio" means it contains a sulfur group, strong respiratory depressant, ultrashort duration (≈30 minutes)

Barbiturate

Benzodiazepines

Diazepam (Valium®)

Midazolam (Versed®)

Lorazepam (Ativan®)

Diazepam

Valium®

MOA: Binds to the benzodiazepine recognition site that modulates the GABA binding to

GABA-A

Metabolized to oxazepam

Long-acting so its not used very often

Benzodiazepine

 Midazolam

Versed®

MOA: Binds to the benzodiazepine recognition site that modulates the GABA binding to

GABA-A

Drug of choice for surgical procedures

Half-life: 30 minutes-1 hour

Benzodiazepine 

Lorazepam

Ativan®

MOA: Binds to the benzodiazepine recognition site that modulates the GABA binding to

GABA-A

Has additive that is similar to polyethylene glycol which is used in antifreeze

Benzodiazepine

Flumazenil

Romazicon®

Used as an antidote for benzodiazepine overdose

Ketamine

Ketalar®

MOA: Blocks glutamic acid N-methyl-D-aspartate (NMDA) receptors

Structurally similar to phencylidine (PCP), good for hypotensive patients because it increases the blood pressure slightly, causes a dissociative feeling where you feel like your body is disconnected from you

Phenol, Ketone

Phenols

Fospropofol (Lusedra®)

Propofol (Diprivan®)

Fospropofol

Lusedra®

MOA: Enhancement of GABA-A

Metabolized to Propofol

Has no injection site pain but is more expensive than propofol

Phenol

Propofol

Diprivan®

MOA: Enhancement of GABA-A

Produces CV and Respiratory depression, rapidly penetrates the BBB

Phenol

Miscellaneous General Anesthetics

Etomidate (Amidate®)

Dexmedetomidine (Precedex®)

Droperidol (Inapsine®)

Diethyl Ether

Chloroform

Etomidate

Amidate®

MOA: Positive allosteric modulator of GABA-A receptors

Less respiratory depression than thiopental

Miscellaneous

Dexmedetomidine

Precedex®

S-enantiomer of medetomidine

Miscellaneous

Droperidol

Inapsine®

Tranquilizer, it also reduces nausea and vomiting during procedures

It may cause fatal heart problems (Infrequent)

Miscellaneous

Diethyl Ether

No brand name available

It forms peroxide

Irritating to the respiratory tract & causes coughing

Miscellaneous

Chloroform

No brand name available

Sensitizes the heart & causes arrhythmias, also causes liver toxicity so it was discontinued

Miscellaneous

Inahaled Anesthetics

Nitrous Oxide (Maxicool®)

Halothane

Methoxyflurane (Penthrane®)

Enflurane (Ethrane®)

Isoflurane (Forane®)

Desflurane (Suprane®)

Sevoflurane (Ultane®)

Nitrous Oxide

Maxicool®

MOA: Blocks NMDA (**Ardley says it modulates GABA-A, Fitz says it blocks NMDA**)

Inhaled Anesthetic

Halothane

Brand Name has beed discontinued

 Mimics Nitrous Oxide

Not as toxic as chloroform but it does cause liver toxicity, causes respiratory and myocardium depression, sensitizes the myocardium to catecholamines

Inhaled Anesthetics

Methoxyflurane

Penthrane®

Not used because of long onset (≈ 20 minutes), also kidney toxicity

0.8% needed for stage 3 anesthesia

Inhaled Anesthetic 

Enflurane

Enthrane®

Onset of action: 5-10 minutes, no kidney toxicity

Not as depressive to myocardium

Inhaled Anesthetics

Isoflurane

Forane®

Onset of action: 5-10 minutes

Not as depressant to myocardium, no kidney toxicity

Has better CV side effect profile than Enflurane

Inhaled Anesthetics

Desflurane

Suprane®

Rapid onset: 1-2 minutes

Similar CV profile to Enflurane and Isoflurane, does cause CV and respiratory depression

Irritates the respiratory tract & causes coughing, smells bad

Inhaled Anesthetics

Sevoflurane

Ultane®

Onset of action: 2-5 minutes

Similar CV profile to Desflurane, not as foul smelling, less coughing

Inhaled Anesthetics

Skeletal Muscle Relaxants used as adjunct therapy for general anesthetics

Used to relax lungs for patients that require intubation

Succinylcholine (Anectine®)

Atracurium (Tracrium®)

Cisatracurium (Nimbex®)

Pancuronium (Pavulon®)

Vecuronium (Norcuron®)