Other nonvolatile anesthetic agents

Question 1

Which induction agents reduce ICP?

Answer 1

propofol, thiopental, and etomidate

Question 2

Which induction agent raises ICP?

Answer 2

ketamine

Question 3

Which induction agent has no effect on ICP?

Answer 3

precedex

Question 4

Two common side effects seen during emergence from ketamine.

Answer 4

combativeness and delirium

Question 5

Ketamine produces this type of anesthesia.

Answer 5

dissociative (the thalamus is dissociated from the limbic cortex. sound and vision are mixed up)

Question 6

Ketamine dose - induction

Answer 6

1 - 2 mg/kg IV

3 - 5 mg/kg IM

Question 7

Ketamine is an antagonist of what receptor?

Answer 7

N-methyl-D-aspartate (NMDA)

Question 8

Does ketamine increase or decrease arterial blood pressure, heart rate, and cardiac output?

Answer 8

increase

Question 9

Due to ketamine’s effects on the cardiovascular system, its use should be avoided in patients with these diagnoses.

Answer 9

coronary artery disease, uncontrolled hypertension, congestive heart failure, and arterial aneurysms

Question 10

Large doses of this medication cause direct myocardial depression.

Answer 10

ketamine

Question 11

Ketamine has _______ stimulatory effects on the sympathetic nervous system.

Answer 11

indirect

Question 12

Is ketamine a bronchoconstrictor?

Answer 12

no, it is a potent bronchodilator. it is a good induction agent for asthmatic patients.

Question 13

T or F, ketamine causes increased salivation?

Answer 13

true

Question 14

This medication is the closest thing to being a “complete” anesthetic, as it induces analgesia, amnesia, and unconsciousness.

Answer 14

ketamine

Question 15

This medication attenuates ketamine’s cardio-stimulatory effects and prolongs its elimination half-life.

Answer 15

diazepam

Question 16

Etomidate dose - induction

Answer 16

0.2 - 0.5 mg/kg IV

Question 17

Propofol dose - induction

Answer 17

1 - 2.5 mg/kg IV

Question 18

Propofol dose - maintenance infusion

Answer 18

50 - 200 mcg/kg/min IV

Question 19

Propofol dose - sedation infusion

Answer 19

25 - 100 mcg/kg/min IV

Question 20

Etomidate’s mechanism of action

Answer 20

depresses the reticular activating system and mimics the inhibitory effects of GABA (specifically it appears to bind to a subunit of the GABA type A receptor, increasing its affinity for GABA)

Question 21

What is the name of the active metabolite of ketamine?

Answer 21

norketamine (it is an active metabolite, but is less potent than ketamine)

Question 22

Long-term infusions of etomidate can lead to this?

Answer 22

adrenocortical suppression (induction doses of etomidate transiently inhibit enzymes involved in cortisol and aldosterone synthesis)

Question 23

How is etomidate metabolized?

Answer 23

by hepatic enzymes and plasma esterases

Question 24

Etomidate can cause sudden, generalized, asynchronous muscle contractions known as what?

Answer 24

myoclonia

Question 25

Propofol mechanism of action

Answer 25

GABA interaction (hyperpolarization of chloride ion channels)

Question 26

Is the pH of propofol hypertonic, isotonic, or hypotonic?

Answer 26

isotonic (7.0 - 8.5)

Question 27

Is propofol contraindicated in patients with an egg allergy?

Answer 27

no

Question 28

What percentage of propofol is protein bound?

Answer 28

98%

Question 29

Potentiation of effects will be seen when propofol is given with these types of medications.

Answer 29

sedatives and narcotics

Question 30

T or F, propofol has antipruritic and antiemetic effects?

Answer 30

true

Question 31

How is propofol metabolized?

Answer 31

CYP450 (then the metabolites are excreted by the kidneys)

Question 32

The major cardiovascular effect of propofol is a decrease in what? (and this is due to what three things?)

Answer 32

arterial blood pressure (due to a drop in systemic vascular resistance [inhibition of sympathetic vasoconstricor activity], cardiac contractility, and preload)

Question 33

Propofol depresses the body's normal response to? (pulmonary in nature)

Answer 33

hypercarbia

Question 34

Propofol should be used cautiously in these patient populations

Answer 34

sulfite allergy (new formulation has sulfite ingredient), hypovolemic, cardiac issues (fixed CO - aortic stenosis), or elderly

Question 35

How does etomidate's short duration of action differ from propofol's short duration of action?

Answer 35

etomidate is metabolized by esterases. propofol is rapidly redistributed.

Question 36

Is ketamine a weak acid or base?

Answer 36

weak base

Question 37

Is propofol a weak acid or base?

Answer 37

weak acid

Question 38

What is the onset of propofol?

Answer 38

30 seconds

Question 39

What is the duration of propofol?

Answer 39

2 - 8 minutes

Question 40

What is the onset of ketamine?

Answer 40

30 - 60 seconds

Question 41

What is the duration of ketamine?

Answer 41

10 - 20 minutes

Question 42

Ketamine is a structural analogue of...

Answer 42

phencyclidine