Induction + Pain Management - Quiz 3 Flashcards Preview

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1

Etomidate

Causes Hypnosis

No Pain Properties

Minimal CV Effects

2

Etomidate's Chemical Structure

Carboxylated Imidazole

2 Isomers: R+ is active

PG Solvent

pH: 8.1

Only induction med that is NOT racemic mixture

3

Etomidate MOA

Potentiates GABAA mediated Chloride Shift

Act like Barbs at Higher Doses

4

Etomidate Pharmacokinetics

  • Rapid half-life, Rapid Total Clearance
  • Single Dose - extremely short duration (3-5 min)
  • Peak: 1 min
  • Protein Bound
  • 3 Compartment Model
  • Hepatic extraction
  • Minimal Buildup - can redose

5

What limits use of Etomidate

Transient Depression of Adrenocortical Function

  • Lasts 4-8 hrs.
  • Reversible
  • increased mortality in Septic/Hemorrhaging Pts.
  • Advantage: stress free anesthetic

6

Etomidate CNS Effects

Decreased CBF

Decreased CMRO2

Decreased ICP while maintaining CPP

Maintains cerebral vessel response to CO2

Decrease IOP

7

Etomidate CV Effects

CV stability - minimal changes

except

Pts. w/ aortic stenosis or mitral valve disease - significant drop in BP, PAP, PCWP

8

Etomidate Respiratory Effects

Decrease Minute Volume

Compensatory increase RR

Decrease ventilatory response to CO2

Apnea followed by Hyperventilation

9

Etomidate's other effects

PONV

Does NOT effect duration of seizure

Myoclonic Jerks (decreased w/ prior opioid med)

No Histamine Release

Low Allergy Risk

10

Precedex

Highly Selective Alpha 2 Agonist

1600 : 1  - alpha2 : alpha 1

(220 : 1 for Clonidine)

Water Soluble

D-isomer is the Active Part

11

Precedex MOA

Negative Feedback on a2 receptors and makes a2 agonist effects

Sleep mimics Normal sleep

Pain Properties

Tolerance happens

12

Why is Clonidine sometimes used on kids?

Adjunct therapy for ADHD

13

Precedex Pharmacokinetics

Protein Bound

Rapid Hepatic Metabolization

Excreted in Urine & Bile

Rapidly Cleared

14

Precedex CNS Effects

Decrease CBF

No ICP Change

No CMRO2 Change

Decrease Plasma Catecholamine

Decrease MAC Requirement

Decrease need for Opioid

15

Precedex CV Effects

Moderate ↓HR & ↓SVR

Bolus may cause brief increase in BP & Bradycardia

16

Precedex Respiratory Effects

Small ↓Tidal Volume

No signifcant change in RR

No change to CO2 Response

Mild Airway Obstruction

Synergistic w/ other Sedatives

17

What is the max infusion time for Precedex per the package insert?

24 Hours

Still safe after 24hrs, but you might see lack of effect and changes in blood pressure.

18

Precedex Withdrawal

Upregulation of Receptors

An abrupt stop = accelerated HTN

Higher risk of HTN for pts who are already at risk. 

19

General Anesthetics and Preggos

  • Black Box Warning: causes poor cognitive and school performance for the kid

20

General Anesthetics and Preggos:

American College of Ob/Gyn

Disagrees w/ Black Box Warning - Can't generalize based on animal testing

21

General Anesthetics and Preggos

JAMA

Sibling Study: No adverse effects in child development

 

22

General Anesthetics and Preggos

MASK Trial

Single Exposure: No deficits

Secondary Exposure: Possible deficits in processing speeds and fine motor skills

23

Nociceptive Pain

Has obvious site of pain

24

Nociceptive Stimulation

Noxious Stimuli release neural chemicals that stimulate other nociceptors

  • Bradykinin, Substance P, Potassium, Histamine, Prostaglandin, Luekotriens
  • Transmits signal to Spinal Cord

25

Nociceptive Transmission

Action potential moves from stimuli site to dorsal horn of spinal cord, then CNS

  • Many pathways
  • A Fibers: large diameter, myelinated - sharp pain
  • C Fibers; small diameter, unmyelinated - dull, aching pain

26

What are released from the dorsal horn during nociceptive transmission?

Glutamate

Substance P

Calcitonin Peptide

27

Nociceptive Perceception

Conscious Pain Experience

Impulse relayed thru thalamus

28

Nociceptive Modulation

Impulse Inhibition via Brain Stem

  • Body's opioid
  • Serotonin
  • Norepi
  • GABA

29

 Neuropathic Pain

Does NOT follow pain cascade

Nerve Misfire

Never damage, Persistance Stimulation, Autonomic Dysfunction

Burning, tingling, shocks, hyperalgesia, headache

30

What is Chronic Pain

> 3 months or past the time of normal healing

20% of non cancer pts. receive opiods