Lecture 4- Exam 4

Question 1

What is the role of sedation:

Answer 1

Facilitation of painful procedures

Question 2

List the spectrum of sedation:
(lowest to highest)

Answer 2

1. anxiolysis
2. moderate sedation
3. deep sedation
4. anesthesia (intubation required)

Question 3

Dissociative sedation is done with:

Answer 3

Ketamine

Question 4

The patient is dissociated from what is going on around them:

Answer 4

Dissociative sedation

Question 5

Dissociative sedation is not on a:

Answer 5

spectrum (on and off switch)

Question 6

List the neurophysiologic effects produced by anesthetics:

Answer 6

1. unconsciousness
2. amnesia
3. analgesia
4. inhibitionof autonomic ref;exes
5. skeletal muscle relaxation

Question 7

List the aspects of the PERFECT aneshetic:

Answer 7

1. optimizes procedure performance
2. minimize patient movement
3. maximize patient comfort
4. no side effects
5. provides sedative/hypnotic effect, analgesia, amnesia
6. minimal cardiovascular and respiratory effects
7. rapid onset, short acting, or reversible

Question 8

What is the most frequently used (historically) IV sedative?

Answer 8

Etomidate

Question 9

What effect is Etomidate missing from “ideal anesthetics”?

Answer 9

No analgesia

Question 10

What quality of “ideal anesthetics” does Etomidate provide?

Answer 10

1. Hypnotic
2. Rapid onset
3. Short duration of action

Question 11

What is the dosing of Etomidate?

Answer 11

0.3mg/kg IV

Question 12

Etomidate has a neutral hemodynamic profile, what does this mean?

Answer 12

It will not increase or decrease BP and has neutral effect on the HR as well

Question 13

Etomidate can cause ____ which was originally confused as causing a seizure

Answer 13

Myoclonic activity (muscle spasms)

Question 14

What type of activity is increased with Etomidate?

Answer 14

EEG activity (clinically insignificant unless patient is actively having a seizure)

Question 15

Etomidate is emetogenic meaning:

Answer 15

May cause vomiting in some patients

Question 16

-Neutral hemodynamic profile
-Myoclonic activity
-EEG activity increased
-Emetogenic
-Short acting
-Rapid onset
-0.3mg/kg
-hypnotic

Answer 16

Etomidate

Question 17

What are the negative aspects of Etomidate?

Answer 17

1. inhibits 11-B hydroxylase
2. Adrenal suppression

Question 18

What is 11-B hydroxylase responsibe for?

Answer 18

Converting cholesterol into cortisol

Question 19

What is a way to avoid adrenal suppression when administering Etomidate?

Answer 19

To only give one dose

Question 20

Used more commonly as an anxiolytic to take the edge off:

Answer 20

Benzodiazepine

Question 21

A benzodiazepine that is most frequently used for sedation in the setting:

Answer 21

Midazolam

Question 22

The most lipid soluble benzodiazepine:

Answer 22

Midazolam

Question 23

Midazolam is the most lipid soluble benzodiazepine, what does this mean?

Answer 23

It has the most rapid onset of all the benzodiazepines (anything that is lipid soluble tends to work faster)

Question 24

What is the brand name for Midazolam?

Answer 24

Versed

Question 25

What is the downfall of Midazolam (Versed)?

Answer 25

Slower offset of action, and the effect is unreliable, making it difficult to titrate

Question 26

If a patient comes in with a higher baseline need of GABA (ex- like someone who drinks a case of beer/day) what would the dosing of Midazolam look like?

Answer 26

Would require a lot more to have effect

Question 27

T/F: For a patient for just needs the edge taken off, Midazolam is an appropriate drug choice

Answer 27

True

Question 28

T/F: For a patient who is undergoing a lengthy procedure, Midazolam is an appropriate drug choice

Answer 28

False

Question 29

Describe the amnesia and analgesia effects of benzodiazepines:

Answer 29

Great amnesia and no analgesia

Question 30

Reversal agents for Benzodiazepines:

Answer 30

Flumazenil

Question 31

If a patient that has OD on Xanax and is oversedated, what could you give them and why or why not would this be a good idea?

Answer 31

You could give them Flumazenil which would reverse the effects of the benzodiazepine however this would put them in a hyperexcitatory state and increases the risk of a seizure If they have a seizure we would typically give them ativan (a benzo) which now has no where to bind and therefore no effect on stopping the seizure The next best option would be to give an antiepileptic which takes 20 min to work and now our patient probably has brain damage

Question 32

How does Flumazenil work to reverse benzos?

Answer 32

Binds up with the benzodiazepine receptor site, antagonizing the effects by kicking the benzodiazepines off and binds it up so the benzos can't bind any longer, so GABA can't bind any longer and will reverse the effect pretty quickly

Question 33

Propofol is classified as:

Answer 33

GABA agonist

Question 34

Propofol is a ____ emulsion, meaning it works ____

Answer 34

lipid emulsion; quick onset, quick offset

Question 35

Describe the timeliness of Propofol:

Answer 35

Quick onset, quick offset (Quick on because it gets in the brain quickly (lipid) and quick off because it gets distributed throughout the body pretty quickly

Question 36

Desribe the analgesic effects of Propofol:

Answer 36

No analgesia

Question 37

-GABA agonist -Quick on, quick off -Lipid emulsion -No analgesia -no definitive dose response

Answer 37

Propofol

Question 38

Procedural sedation for propofol: Anesthesia dosing for propofol: Sedation for mechanical ventilation with propofol:

Answer 38

1mg/kg IV followed by 0.5mg/kg IV 2-3mg/kg induction then max 200 mcg/kg/min for maintenance max 75mcg/kg/min

Question 39

What are three things to keep in mind when administering Propofol?

Answer 39

1. burns on administration 2. negative ionotrope (meaning it will drop BP) 3. respiratory depression

Question 40

What is a contraindication for propofol use?

Answer 40

Due to it being a negative ionotrope (causes a drop in BP) you would not want to give this drug to someone with hypotension