IV Anesthetics

Question 1

What effect does propofol have on arterial blood pressure?

Answer 1

Decrease in arterial BP due to drop in SVR

Inhibition of sympathetic vasoconstrictor activity contributes to this effect.

Question 2

What usually reverses hypotension following induction of propofol?

Answer 2

Stimulation accompanying laryngoscopy and intubation

Question 3

What factors are associated with propofol-induced hypotension?

Answer 3

Large dose, rapid injection, old age

Question 4

How does propofol affect heart rate and cardiac output?

Answer 4

Transient and insignificant but may be life threatening in extreme age, BB patients, and impaired LV function

Question 5

What rare effect can occur due to marked drop in cardiac filling when using propofol?

Answer 5

Vagally mediated bradycardia

Question 6

What is the effect of propofol on respiration?

Answer 6

Profound respiratory depressant that usually causes apnea following an induction dose

Question 7

What ventilatory drive does propofol inhibit even at small doses?

Answer 7

Hypoxia ventilatory drive and normal response to hypercarbia

Question 8

What reflex does propofol depress?

Answer 8

Upper airway reflex

Question 9

How does the incidence of wheezing with propofol compare to barbiturates?

Answer 9

Lesser incidence of wheezing in both asthmatic and non-asthmatic patients

Question 10

What cerebral effects does propofol have?

Answer 10

Decrease CBF, CBV, ICP, and IOP

Question 11

What additional effects does propofol have?

Answer 11

Antiemetic, antipruritic, anticonvulsant effect

Question 12

What excitatory phenomena can occur during propofol induction?

Answer 12

Muscle twitching, spontaneous movement, opisthotonus, hiccuping

Question 13

What effect does midazolam have on the required propofol dose?

Answer 13

Reduces the required propofol dose by more than 10%

Question 14

Which drugs can propofol be combined with for TIVA?

Answer 14

• Remifentanil
• Dexmedetomidine
• Ketamine

Question 15

What is the mechanism of action of Propofol?

Answer 15

Potentiate GABA by activation of CL channel leading to neuron hyperpolarization.

Action is not reversed by flumazenil.

Question 16

What is the composition of Propofol?

Answer 16

Oil in water emulsion composed of soybean oil, glycerol, and egg lecithin.

Should be used within 6 hours of opening ampule.

Question 17

What is the recommended induction dose of Propofol?

Answer 17

1-2.5 mg/kg.

Question 18

What is the maintenance infusion dose range for Propofol?

Answer 18

50-200 mcg/kg/min.

Question 19

What is the sedation infusion dose range for Propofol?

Answer 19

25-100 mcg/kg/min.

Question 20

What is the lipid solubility characteristic of Propofol?

Answer 20

Highly lipid soluble.

Question 21

What is the fast first distribution half-life duration of Propofol?

Answer 21

2-8 minutes.

Question 22

How does aging affect the dosing of Propofol?

Answer 22

Dose should be less due to low volume of distribution.

Question 23

What does the clearance of Propofol exceed?

Answer 23

Hepatic blood flow.

Question 24

What does the clearance of Propofol imply about its metabolism?

Answer 24

Existence of extra-hepatic metabolism.

Question 25

What organs contribute to the extra-hepatic metabolism of Propofol?

Answer 25

Lungs, kidneys, and possibly the brain.

Question 26

Does obesity affect the pharmacokinetics of Propofol?

Answer 26

No.

Question 27

How does end-stage kidney disease affect the clearance of Propofol?

Answer 27

Does not affect the clearance.

Question 28

Where are the metabolites of Propofol primarily excreted?

Answer 28

In the urine.

Question 29

What class of drugs does Ketamine belong to?

Answer 29

Dissociative anesthetics

Question 30

What is the mechanism of action of Ketamine?

Answer 30

1. Antagonist of N-methyl D-aspartate in CNS 2. Enhances sympathetic nervous system by inhibiting the reuptake of catecholamines

Question 31

What are the routes of administration for Ketamine?

Answer 31

IV, IM, rectal, nasal, SC

Question 32

What is the onset time for Ketamine when administered IV?

Answer 32

30 seconds

Question 33

What is the onset time for Ketamine when administered IM?

Answer 33

2-4 minutes

Question 34

How is Ketamine metabolized?

Answer 34

Hepatic metabolism via CYP450, producing norketamine

Question 35

What is the potency of norketamine compared to Ketamine?

Answer 35

1/3 to 1/5 potency of Ketamine

Question 36

How is Ketamine excreted from the body?

Answer 36

In urine and bile

Question 37

What type of state does Ketamine produce in patients?

Answer 37

Dissociative state

Question 38

What type of pain is Ketamine excellent at relieving?

Answer 38

Somatic pain

Question 39

What type of amnesia does Ketamine cause?

Answer 39

Retrograde and anterograde amnesia

Question 40

What is the emergence phenomenon associated with Ketamine?

Answer 40

Hallucinations, vivid dreams, or delirium upon awakening

Question 41

What can reduce the emergence phenomenon when using Ketamine?

Answer 41

Premedication with benzodiazepines or co-administration with propofol

Question 42

What effect does Ketamine have on cerebral blood flow (CBF) and intracranial pressure (ICP)?

Answer 42

Increase in CBF and ICP

Question 43

What caution should be taken with Ketamine in neurosurgery patients?

Answer 43

Caution due to increased CBF and ICP

Question 44

What effect does Ketamine have on intraocular pressure (IOP)?

Answer 44

Mild increase in IOP

Question 45

What cardiovascular effects does Ketamine have?

Answer 45

Increase in HR, BP, and CO

Question 46

What condition may attenuate the cardiovascular effects of Ketamine?

Answer 46

Catecholamine depleted patients (e.g., trauma or sepsis)

Question 47

What is the respiratory effect of Ketamine?

Answer 47

Minimal respiratory depression, preserves airway reflexes and spontaneous breathing

Question 48

What benefit does Ketamine provide to patients with asthma?

Answer 48

Bronchodilation

Question 49

What can be used to counteract increased salivation from Ketamine?

Answer 49

Pretreatment with glycopyrrolate

Question 50

What is the induction dose of ketamine for IV administration?

Answer 50

1-2 mg/kg ## Footnote This dosage is specific for induction purposes.

Question 51

What is the induction dosage for IM administration of ketamine?

Answer 51

3-5 mg/kg ## Footnote This dosage is specific for induction purposes.

Question 52

What is the sedation dosage of ketamine range for IV administration?

Answer 52

0.1-0.5 mg/kg ## Footnote This dosage is used for sedation.

Question 53

What is the analgesia dosage of ketamine for IV administration?

Answer 53

0.2-0.5 mg/kg ## Footnote This dosage is used for analgesia.

Question 54

What is ketamine infusion dosage for analgesia?

Answer 54

0.1-0.5 mg/kg/h ## Footnote This dosage is used for continuous analgesia infusion.

Question 55

What are CNS side effects of ketamine ?

Answer 55

* Emergence reactions * Increased CBF/CP * Hallucination ## Footnote These side effects are related to the central nervous system.

Question 56

What cardiovascular side effects can occur while using ketamine ?

Answer 56

* Hypertension * Tachycardia ## Footnote These side effects are related to cardiovascular function.

Question 57

What are respiratory side effects of ketamine?

Answer 57

* Minimal depression * Hyper salivation ## Footnote These side effects pertain to respiratory function.

Question 58

What are other potential side effects of ketamine ?

Answer 58

* Vomiting * Increased IOP ## Footnote These side effects can occur but are not classified under CNS, CVS, or respiratory.

Question 59

What is a contraindication of ketamine related to CNS?

Answer 59

Increased ICP ## Footnote This condition poses a risk for patients receiving the medication.

Question 60

What is a contraindication related to ocular pressure?

Answer 60

Increased IOP ## Footnote This condition poses a risk for patients receiving the medication.

Question 61

What cardiovascular conditions are contraindicated?

Answer 61

* Severe coronary artery disease * Uncontrolled hypertension ## Footnote These conditions can complicate the use of the medication.

Question 62

What psychological history is a contraindication when using ketamine ?

Answer 62

History of psychosis ## Footnote This history can lead to adverse reactions.

Question 63

What is the mechanism of action of Etomidate ?

Answer 63

Enhances gamma-aminobutyric acid (GABA) neurotransmission by acting on GABA-A receptors ## Footnote Produces hypnosis without significant analgesia.

Question 64

What is the onset time of Etomidate ?

Answer 64

30-60 seconds ## Footnote Rapid onset due to quick redistribution from the brain.

Question 65

What is the duration of action of Etomidate ?

Answer 65

3-5 minutes ## Footnote Short duration due to rapid redistribution.

Question 66

How is Etomidate metabolized?

Answer 66

Undergoes hepatic metabolism via ester hydrolysis and is excreted renally ## Footnote This indicates the drug's elimination pathway.

Question 67

What is the recommended induction dose of Etomidate for general anesthesia?

Answer 67

0.2-0.5 mg/kg IV ## Footnote This dose is typically used for induction.

Question 68

Why Etomidate is preferred for induction in hemodynamically unstable patients?

Answer 68

Due to minimal cardiovascular effects ## Footnote This makes it safer for patients with unstable hemodynamics.

Question 69

What clinical situation Etomidate is commonly used in?

Answer 69

Rapid sequence intubation in critically ill patients ## Footnote It is favored for its rapid action and safety profile.

Question 70

What is one advantage of Etomidate related to hemodynamic stability?

Answer 70

Minimal effects on heart rate, blood pressure, and cardiac output ## Footnote This is crucial for maintaining stability during anesthesia.

Question 71

How does Etomidate affect cerebral metabolism?

Answer 71

Decreases cerebral metabolic rate (CMRO2), cerebral blood flow, and intracranial pressure ## Footnote Useful in neurosurgical cases for these reasons.

Question 72

What is a significant disadvantage of Etomidate related to adrenal function?

Answer 72

Inhibits 11ß-hydroxylase, reducing cortisol and aldosterone synthesis ## Footnote This can be problematic in critically ill or septic patients.

Question 73

What percentage of patients may experience myoclonus as a side effect?(Etomidate)

Answer 73

30-60% ## Footnote Involuntary muscle movements are a common side effect.

Question 74

What is a common postoperative side effect of Etomidate ?

Answer 74

Nausea and vomiting ## Footnote It has a higher incidence compared to other induction agents.

Question 75

What causes pain on injection of Etomidate ?

Answer 75

Its propylene glycol formulation ## Footnote This is a known issue with some injectable anesthetics.

Question 76

True or False: Etomidate has analgesic properties.

Answer 76

False ## Footnote It requires adjuncts for pain management.