Pretreatment with what medication can decrease etomidate-induced myoclonus?
Opioids or benzos (fast onset, not diazepam)
Prolonged infusions of what induction agent increases mortality in ICU patients?
Etomidate (likely secondary to adrenal suppression)
Effects of ketamine on the heart
Increased sympathetics (increased HR, CO, SV) which masks the direct myocardial depression associated with large doses of ketamine
Pretreatment with what medication can decreased ketamine-induced psychotomimetic effects?
Mixing which induction agent and opioids or LR can cause precipitation?
Mechanism of action for thiopental?
Enhances action (increased duration) of GABA action at GABA-A receptor
Induction dose for thiopental
What is the primary mechanism for prompt awakening after induction dose of thiopental?
Treatment of intra-arterial injection of thiopental
Dilution with NS + vasomotor relaxation (lidocaine, papaverine, or phenoxybenzamine) with sympathectomy (i.e. stellate ganglion block) if meds are ineffective
When do you worry about propofol infusion syndrome?
ICU patients, usually pediatric patients, when propofol used at 150-200 mcg/kg/min for hours to days
Signs and symptoms of propofol infusion syndrome?
Progressive bradyarrhythmias, metabolic acidosis, cardiac arrest
How does propofol work?
Stimulates GABA-A receptors
Does propofol injection affect NMB?
Increases depth but not duration
How is etomidate metabolized?
Ester hydrolysis (plasma and hepatic)
How is etomidate excreted?
Inactive metabolites renally
Induction dose of etomidate
Etomidate has what EEG changes?
Can cause epileptiform activity and thus avoided with patients with seizures
Which induction agents do not cause cardio depression?
Etomidate and Ketamine
Which induction agents decrease ICP?
Propofol, thiopental, and etomidate
Which induction agents do not cause respiratory depression?
Etomidate, Ketamine, Midazolam
Which induction agents provide analgesia?
Which induction agents cause porphyria?
Thiopental and etomidate
Which induction agents cause bronchorelaxation?
Which induction agents cause myoclonus?
How does etomidate cause adrenal suppression?
Inhibits 11-beta-hydroxylase which decreases aldosterone and cortisol synthesis
Which induction agents cause significant N/V?
Which induction agents can cause post-op hiccups and sense of restlessness?
Mechanism of action for ketamine
Non-competitive antagonism at NMDA receptors; also has local anesthetic properties; can bind mu-delta-kappa receptors, inhibits reuptake of epi, dopamine, serotonin, NE; blocks Ach receptors (anti-cholinergic symptoms)
What neurotransmitter pairs with NMDA receptors?
Which induction agent increases cerebral blood flow and ICP