Induction Agent Dosages

Question 1

Propofol (alternate name)

Answer 1

Diprivan

Question 2

Propofol structure:

Answer 2

Sedative/hypnotic
2, 6 diisopropylphenol
Lipid soluble, weak acid

Question 3

Propofol MOA:

Answer 3

1. GABA-A agonist (Beta subunit)
2. Decreases rate of dissociation of GABA from receptor increasing the duration of chloride channel opening
3. Hyperpolarizes cell
5. Also inhibits NMDA, stimulates glycine

Question 4

Propofol Onset:

Answer 4

30-60 sec

Question 5

Propofol duration of action:

Answer 5

5-15 min

Question 6

Propofol PB:

Answer 6

98%

Question 7

Propofol metabolism:

Answer 7

CYP3A4, 2B6
60% liver,
30% kidneys,
10% lungs/small intestine

Question 8

Propofol IV induction dose:

Answer 8

IV: 1-2.5 mg/kg (induction)

Question 9

Propofol IV drip dose:

Answer 9

IV: 50-300 mcg/kg/min (maintenance drip)

Question 10

Propofol IV Sedation drip dose:

Answer 10

IV: 25-75 mcg/kg/min (sedation)

Question 11

Propofol IV antiemetic dosing:

Answer 11

IV: 10 mcg/kg/min or
10-20 mg q5-10 min (antiemetic)

Question 12

Propofol side effects:

Answer 12

1. Decreased BP (25-40%)
2. Decreased SV
3. Decreased CO
4. Decreased CBF
5. Decreased CMRO2

Question 13

Propofol Contraindications / cautions:

Answer 13

1. Crosses Placenta
2. Decrease in elderly
3. Discard after 6 hr of drawing up
4. Do not mix with other agents (PE risk)
5. Painful injection (Ph? Propylene glycol?)
6. Myoclonus
7. Bradycardic death
8. Green urine – benign
9. increased Lipid levels

Question 14

Etomidate (alternate name):

Answer 14

Amidate

Question 15

Etomidate structure:

Answer 15

Non-barbiturate hypnotic
imidazole derivative
ester, base, water soluble

Question 16

Etomidate MOA:

Answer 16

1. GABA-A agonist (Beta subunit)
2. Decreases rate of dissociation of GABA from receptor increasing the duration of chloride channel opening
3. Hyperpolarizes cell

Question 17

Etomidate onset:

Answer 17

30-60 sec

Question 18

Etomidate duration of action:

Answer 18

5-15 min

Question 19

Etomidate PB:

Answer 19

75%

Question 20

Etomidate metabolism:

Answer 20

Hepatic ester hydrolysis to ethyl alchohol

Question 21

Etomidate IV dose:

Answer 21

IV: 0.2-0.6 mg/kg (do not exceed 20 mg, induction)

Question 22

Etomidate side effects:

Answer 22

1. Most CV stable (maintains coronary perfusion)
2. Myoclonus
3. PONV (30-40%)
4. Adrenocortical suppression
5. Decrease ICP

Question 23

Etomidate Contraindications / cautions:

Answer 23

1. Painful injection (Propylene glycol)
2. Hiccups
3. Avoid in pt with chronic steroid use
4. Avoid in long surgeries (increased stress response)
5. Avoid if previous anaphylaxis

Question 24

Ketamine (alternate name):

Answer 24

Ketalar

Question 25

Ketamine structure:

Answer 25

Disociative hypnotic Phencyclidine derivative Cyclohexanone hydrochloride base, lipid soluble

Question 26

Ketamine MOA:

Answer 26

1. NMDA noncompetitive antagonist (glutamate normally stimulates opening and permeability to calcium, potassium, and sodium) 2. mu, delta, kappa Opioid agonist 3. 4. Cholinergic receptor agonist (salivation) 5. Also acts on MAO – inhibits 5Ht, dopamine & NE reuptake

Question 27

Ketamine onset:

Answer 27

IV: 30-60 sec IM: 2-4 min

Question 28

Ketamine duration of action:

Answer 28

10-20 min

Question 29

Ketamine PB:

Answer 29

12%

Question 30

Ketamine metabolism:

Answer 30

CYP3A4, 2B6 hepatic demethylation to norketamine

Question 31

Ketamine IV induction dose:

Answer 31

IV: 0.5-2 mg/kg

Question 32

Ketamine IM induction dose:

Answer 32

IM: 4-8 mg/kg

Question 33

Ketamine IV maintenance dose:

Answer 33

IV: 5-10 mg boluses up to 0.5 mg/kg throughout procedure

Question 34

Ketamine IV sedation/analgesia dose:

Answer 34

IV: 0.2-0.5 mg/kg q 2-3 min (sedation/analgesia)

Question 35

Ketamine IM sedation/analgesia dose:

Answer 35

IM: 2-4 mg/kg (sedation/analgesia)

Question 36

Ketamine side effects:

Answer 36

1. Bronchodilation 2. Tachycardia 3. Dissociative state 4. Increased salivation 5. Nystagmus

Question 37

Ketamine Contraindications / cautions:

Answer 37

1. Avoid in open eye injury 2. Avoid in increased ICP 3. Avoid in pulmonary hypertension 4. Does not block pharyngeal/laryngeal reflex 5. Avoid as sole anesthetic for CAD (myocardial depressant) 6. Emergence delirium 7. Minimal effect on respiratory drive (minimal apnea risk) 8. Inhibits NE reuptake (increased BP, increased HR, increased CO) 9. Always give Versed as well 10. Don’t give to schizophrenia patients 11. May cause hypotension in catecholamine depleted pts