Induction Agents

Question 1

What is the standard IV induction dose of propofol for a healthy adult?

Answer 1

1.5–2.5 mg/kg

Standard dosing for propofol in adults.

Question 2

What is the usual onset time of action for propofol IV?

Answer 2

10–20 or 15-30 seconds

Rapid onset characteristic of propofol.

Question 3

How long does a single IV bolus of propofol usually last?

Answer 3

2-8 minutes

Duration of action for propofol.

Question 4

What is the primary mechanism of action of propofol?

Answer 4

GABA-A receptor potentiation

Propofol enhances GABA-A receptor activity.

Question 5

Which of the following is a known clinical effect of propofol?

Answer 5

Antiemesis

Propofol has antiemetic properties.

Question 6

Which clinical scenario is propofol preferred over etomidate?

Answer 6

Sedation for short outpatient procedures with PONV risk

Propofol is often used in outpatient settings.

Question 7

Which side effect of propofol is most commonly observed during induction?

Answer 7

Hypotension

Hypotension is a notable side effect during induction.

Question 8

Which formulation property of propofol requires strict aseptic technique during handling?

Answer 8

Lipid emulsion base

The lipid emulsion increases the risk of contamination.

Question 9

Propofol has both hypnotic and analgesic properties.

Answer 9

False

Propofol is primarily hypnotic, not analgesic.

Question 10

Propofol can cause dose-dependent respiratory depression.

Answer 10

True

Respiratory depression is a risk with higher doses.

Question 11

Propofol reduces intracranial pressure and cerebral metabolic rate.

Answer 11

True

Beneficial effects on ICP and CMRO₂.

Question 12

The antiemetic effect of propofol makes it suitable for patients with high PONV risk.

Answer 12

True

Antiemetic properties are advantageous for PONV.

Question 13

Propofol is primarily metabolized in the kidneys.

Answer 13

False

It is metabolized in the liver.

Question 14

Propofol infusion syndrome is more common with prolonged high-dose infusions.

Answer 14

True

PRIS is associated with high-dose and prolonged use.

Question 15

Propofol causes minimal cardiovascular depression, making it ideal in hypotensive patients.

Answer 15

False

Propofol can cause hypotension.

Question 16

What is the typical induction dose range of propofol in mg/kg?

Answer 16

1.5–2.5 mg/kg IV

Standard dosing for IV induction.

Question 17

Name two reasons propofol is often chosen for outpatient or ambulatory surgery.

Answer 17

• Rapid onset
• Recovery, antiemetic properties

Key benefits for outpatient procedures.

Question 18

What syndrome is associated with prolonged, high-dose propofol infusion?

Answer 18

Propofol Infusion Syndrome (PRIS)

A serious complication of prolonged use.

Question 19

List three key clinical effects of propofol on the CNS, respiratory system, and cardiovascular system.

Answer 19

• CNS: decreased ICP and CMRO₂
• Respiratory: apnea and depression
• Cardiac: hypotension and bradycardia

Diverse effects across systems.

Question 20

In what type of patient should you use caution when giving propofol?

Answer 20

Patients who are hemodynamically unstable or hypovolemic due to its hypotensive effects

Caution due to hypotensive properties.

Question 21

Why does propofol cause pain on injection, and how can this be minimized?

Answer 21

Due to the lipid emulsion; pain can be reduced by lidocaine pretreatment or larger vein use

Common issue with administration.

Question 22

What is the typical IV induction dose of etomidate in an adult?

Answer 22

0.1–0.4 mg/kg

Standard dosing for etomidate.

Question 23

What is the approximate onset time of etomidate when given intravenously?

Answer 23

15–30 or 5-15 seconds

Quick onset characteristic of etomidate.

Question 24

How long does the hypnotic effect of a single etomidate dose typically last?

Answer 24

5–10 or 3-8 minutes

Duration of action for etomidate.

Question 25

What is the main mechanism of action of etomidate?

Answer 25

Potentiation of GABA-A receptors and depresses RAS ## Footnote Mechanism involves GABA-A receptor enhancement.

Question 26

Which of the following best describes etomidate’s cardiovascular profile during induction?

Answer 26

Preserves hemodynamic stability ## Footnote Minimal cardiovascular effects.

Question 27

Etomidate is most appropriate in which clinical scenario?

Answer 27

A trauma patient with severe hypotension ## Footnote Ideal for hemodynamically unstable patients.

Question 28

Which enzyme is inhibited by etomidate, leading to adrenal suppression?

Answer 28

11-β-hydroxylase ## Footnote Inhibition leads to decreased cortisol production.

Question 29

Which of the following is a common side effect of etomidate after administration?

Answer 29

Myoclonus ## Footnote Myoclonus can occur post-administration.

Question 30

Etomidate causes minimal respiratory depression compared to propofol.

Answer 30

True ## Footnote Etomidate is advantageous for respiratory stability.

Question 31

Etomidate provides both hypnotic and analgesic effects.

Answer 31

False ## Footnote Etomidate is primarily hypnotic.

Question 32

Etomidate is useful for patients with head trauma due to its reduction in intracranial pressure.

Answer 32

True ## Footnote Beneficial effects on ICP.

Question 33

Repeated doses or continuous infusions of etomidate are commonly used in ICU sedation.

Answer 33

False ## Footnote Not recommended due to adrenal suppression.

Question 34

Pain on injection can occur with etomidate use.

Answer 34

True ## Footnote Injection discomfort is possible.

Question 35

Etomidate does not affect adrenal function with a single induction dose.

Answer 35

False ## Footnote Even a single dose can suppress adrenal function.

Question 36

What is the usual IV induction dose range of etomidate in mg/kg?

Answer 36

0.1–0.4 mg/kg ## Footnote Standard dosing for IV induction.

Question 37

Why is etomidate considered the induction agent of choice in critically ill or hemodynamically unstable patients?

Answer 37

It has minimal effects on blood pressure, heart rate, and cardiac output ## Footnote Stability is key for critical patients.

Question 38

What is the most concerning endocrine side effect of etomidate, especially with repeated use?

Answer 38

Adrenocortical suppression due to inhibition of 11-β-hydroxylase ## Footnote Significant concern in repeated dosing.

Question 39

What physical side effect can occur shortly after etomidate administration and may be mistaken for seizure activity?

Answer 39

Myoclonus ## Footnote Myoclonus can mimic seizures.

Question 40

What are the benefits and drawbacks of using etomidate in neuroanesthesia?

Answer 40

* Benefit: reduces ICP and cerebral metabolic rate * Drawback: does not provide analgesia and causes adrenal suppression ## Footnote Important considerations for neuroanesthesia.

Question 41

How long does it take for etomidate to wear off after a single IV bolus dose?

Answer 41

Approximately 5–10 minutes ## Footnote Quick recovery time.

Question 42

What is the typical IV induction dose of ketamine in adults?

Answer 42

1–2.5 mg/kg ## Footnote Standard dosing for ketamine.

Question 43

What is the onset time of action of ketamine given IV?

Answer 43

10–30 or 15-30 seconds ## Footnote Rapid onset characteristic of ketamine.

Question 44

What is the approximate duration of a single IV bolus of ketamine?

Answer 44

10–20 or 5-15 minutes ## Footnote Duration of action for ketamine.

Question 45

Which receptor is primarily antagonized by ketamine?

Answer 45

NMDA receptor ## Footnote Ketamine's primary mechanism of action.

Question 46

Which of the following is NOT a typical clinical effect of ketamine?

Answer 46

Bronchoconstriction ## Footnote Ketamine typically causes bronchodilation.

Question 47

Which patient population might benefit most from ketamine for induction?

Answer 47

Hypovolemic trauma patients ## Footnote Ketamine is useful in trauma scenarios.

Question 48

What is a common psychological side effect of ketamine during emergence?

Answer 48

Hallucinations and delirium ## Footnote Psychological effects during recovery.

Question 49

Which property makes ketamine useful in asthmatic patients?

Answer 49

Potent bronchodilation ## Footnote Beneficial for patients with bronchospasm.

Question 50

Ketamine causes significant respiratory depression similar to propofol.

Answer 50

False ## Footnote Ketamine typically preserves respiratory function.

Question 51

Ketamine increases heart rate and blood pressure.

Answer 51

True ## Footnote Ketamine can stimulate cardiovascular parameters.

Question 52

Ketamine can be administered via IV, IM, oral, intranasal, and rectal routes.

Answer 52

True ## Footnote Versatile administration routes for ketamine.

Question 53

Ketamine is contraindicated in patients with increased intracranial pressure.

Answer 53

Historically True, but now considered controversial and patient-specific ## Footnote Clinical guidelines have evolved.

Question 54

Ketamine is a useful drug for procedural sedation in pediatric patients.

Answer 54

True ## Footnote Commonly used in pediatric sedation.

Question 55

Ketamine causes dissociative anesthesia by blocking GABA receptors.

Answer 55

False ## Footnote It blocks NMDA receptors, not GABA.

Question 56

Ketamine maintains pharyngeal and laryngeal reflexes.

Answer 56

True ## Footnote Preserves airway reflexes during sedation.

Question 57

What is the typical IV induction dose range of ketamine in mg/kg?

Answer 57

1–2.5 mg/kg IV ## Footnote Standard dosing for IV induction.

Question 58

Name two clinical effects that make ketamine unique among anesthetic agents.

Answer 58

* Provides analgesia * Preserves airway reflexes ## Footnote Unique properties of ketamine.

Question 59

Why is ketamine often chosen for asthmatic or bronchospastic patients?

Answer 59

It has bronchodilatory effects ## Footnote Useful for patients with airway constriction.

Question 60

What are common emergence phenomena associated with ketamine?

Answer 60

* Hallucinations * Delirium * Vivid dreams ## Footnote Psychological effects on emergence.

Question 61

How can the emergence reactions from ketamine be minimized?

Answer 61

By co-administering benzodiazepines like midazolam ## Footnote Co-administration helps reduce side effects.

Question 62

What is ketamine's effect on cardiovascular parameters?

Answer 62

It increases heart rate, blood pressure, and cardiac output ## Footnote Ketamine's stimulatory effects on the heart.

Question 63

In what clinical situations would ketamine be a poor choice for induction?

Answer 63

Patients with uncontrolled hypertension, ischemic heart disease, or active psychosis… or ICP ## Footnote Contraindications for ketamine use.

Question 64

Ketamine Fun Facts

Answer 64

* Dissociates from Thalamus = nystagmus gaze and prosialogogue * Useful in various clinical scenarios ## Footnote Interesting characteristics of ketamine.

Question 65

Ketamine When to Use

Answer 65

* Chronic Pain/Opioid Use * Burn Patients * Uncooperative Patients IM * Asthmatics and Bronchospasm * Hypovolemia/Trauma ## Footnote Indications for ketamine administration.