IV Anesthetics

Question 1

compare the contributions of distribution and metabolism to the duration of IV anesthetics

Answer 1

distribution- terminates the effects of most anesthetics; determines early rise and decline of anesthetics*

metabolism- plays a small role in termination of effects

Question 2

describe organ system effects for thiopental and midazolam

Answer 2

thiopental- reduces cerebral metabolism, and O2 utilization, reduces cerebral blood flow, protects brain against hypoxic injury; BP may drop transiently; lowers contractility; resp depression

midazolam- reduction in cerebral met and blood flow; hypotension, amnestic dose gives minimal resp depression

Question 3

describe organ system effects for ketamine and etomidate

Answer 3

ketamine- dreams, hallucinations, delirium, increased ICP, antidepressant; myocardial depressant; increased HR, BP, Epi levels due to sympathetic stimulation; bronchodilation, nystagmus

etomidate- lowers cerebral blood flow and ICP; minimal resp depression- lower risk of apnea; does NOT block sympathetics, best for hemodynamic stability desire of CV px

Question 4

describe organ system effects for propofol

Answer 4

reduced cerebral blood flow; decreased BP, HR, and CO; central venous pressure unchanged;

Question 5

the vessel-rich compartment

Answer 5

brain, heart, lungs, liver, splanchnics

Question 6

the fat compartment has what type of volume and flow?

Answer 6

high volume, low flow

Question 7

the muscle compartment has what type of volume?

Answer 7

intermediate (compared to vessel-rich group)

Question 8

describe the distribution of IV anesthetic in the body compartments chronologically

Answer 8

drug goes to the brain and viscera of the vessel-rich group, then also gets high blood flow out to lean muscles, then the last metabolically low key fat starts to pick up more of the dose

Question 9

truth serum; long elimination half life: what terminates its effect?

Answer 9

thiopental

REDISTRIBUTION*

Question 10

clinical uses of thiopental

Answer 10

general anesthetic induction; brain protection

Question 11

best amnestic agents

Answer 11

midazolam* and lorazepam (benzos)

Question 12

uses of benzos: midazolam

Answer 12

premedication before anesthesia, conscious or heavy sedation, induction of anesthesia, anti convulsant

Question 13

opioids are not reliable for..

Answer 13

amnesia; only analgesia *

Question 14

uses of opioids

Answer 14

premedication, maintenance of anesthesia, post op pain control

Question 15

effects of opiods

Answer 15

pruritis- nose and whole body; chest wall rigidity (sympathetics), apnea

Question 16

list of opioids

Answer 16

remifentanil, fentanyl, morphine, hydromorphone, demerol

Question 17

what determines termination of action of remifentanil?

Answer 17

ELIMINATION*, not redistribution

Question 18

unique effect of propofol

Answer 18

fast acting!*

Question 19

remifentanil volume of distribution and elimination clearance

Answer 19

lowest volume of distribution; biggest elimination clearance

Question 20

mechanism of action of analgesia of opioids

Answer 20

opioid G-protein linked receptors*

Question 21

the only IV agent that works mainly by inhibition of stimulatory systems

Answer 21

ketamine* (the closest drug to doing all 5 aspects of anesthesia)

Question 22

this drug provides central sympathetic stimulation

Answer 22

ketamine*