Diethyl EtherB/GMAC
121.92
Nitrous OxideB/GMAC
0.47105
HalothaneB/GMAC
2.30.74
EnfluraneB/GMAC
1.81.68
IsofluraneB/GMAC
1.41.15
DesfluraneB/GMAC
0.426.0
SevofluraneB/GMAC
0.691.7
Muscle Relaxant for induction & maintenance
VecuroniumRocuronium - immediate onset**
Muscle Relaxant for intubation
Succinylcholine
Muscle Relaxant for use in liver & hepatic failure
AtracuriumCisatracurium
Reversal Agents for Non-Depolarizing Muscle Relaxants
Neostigmine & Edrophonium** increase ACh to compete with the inhibitors** be sure to inject anti-muscarinic blockers first!Atropine or Glycopyrrolate
Cardiac Depression for PIA
H
Respiratory Depression for PIA
E
Cerebral Blood Flow Increase PIA
H
Neuromuscular Junction Inhibition
E
Halothane
Alkane*sensitizes myocardium to catecholaminesArrhythmiasFulminant hepatitisbronchodilatoryworst for malignant hyperthermia
Enflurane
seizuresmetabolized to F, can cause renal failurerespiratory depression significant
Isoflurane
neurosurgery
Desflurane
needs special vaporizer bc boils at room tempwatch for CO2 absorber bc if it has gone bad, will pump CO into pt
Sevoflurane
most popular for pediatriccan interact with CO2 absorber to produce nephrotoxic compound Agood with asthmano change in CO
Thiopental
minor surgical proceduresinduction onlyhighly protein boundlong elimination T1/2 bc of high volume of distribution - takes a long time to recover CNS1) reflex tachycardia2) renal insufficiency3) CNS protection4) venous irritation
Propofol
pain on injection - lidocaineno associated N/V - anti-emeticquick recovery CNSCNS protection - decreases convulsion thresholdOR, ICU
Ketamine
IMbronchodilatorcataplexy - nystagmus & intact reflexesmidazolam to prevent emergence hallucinationsgood for trauma bc maintains hemodynamics (bullet wounds)**trauma, inductions, mentally retarded
Etomidate
minimal cardiac effects - good for pts w/ CV hxsevere post-op N/Vtransient adrenal suppressionCNS protection - decrease convulsion threshold”Hurt, jerk and hurl”pain on injectionmyoclonusN/V
Midazolam
reversible with flumazenilbenzodizepineused for anxiety
Opioids
most popular agents for open heart surgerymust remain intubated over nightreverse with naloxonefentanyl most commonrespiratory depression gives you the ceiling