Podcast
Questions and Answers
Which induction agent has distinct antiemetic properties?
Which induction agent has distinct antiemetic properties?
- Ketamine
- Etomidate
- Midazolam
- Propofol (correct)
Which induction agent produces the greatest degree of hypotension and apnea?
Which induction agent produces the greatest degree of hypotension and apnea?
- Propofol (correct)
- Ketamine
- Midazolam
- Etomidate
What is a significant disadvantage to the use of etomidate, particularly as an infusion?
What is a significant disadvantage to the use of etomidate, particularly as an infusion?
- Tachycardia
- Hypertension
- Adrenal suppression (correct)
- Respiratory depression
Which drug produces a dissociative state and has intrinsic analgesic properties?
Which drug produces a dissociative state and has intrinsic analgesic properties?
Which of the following is a potential clinical feature of propofol infusion syndrome?
Which of the following is a potential clinical feature of propofol infusion syndrome?
What is a potential effect of propofol on the respiratory system?
What is a potential effect of propofol on the respiratory system?
What is a potential effect of propofol on the cardiovascular system?
What is a potential effect of propofol on the cardiovascular system?
Which statement about fospropofol (AQUAVAN) is true?
Which statement about fospropofol (AQUAVAN) is true?
What is a potential disadvantage of fospropofol (AQUAVAN)?
What is a potential disadvantage of fospropofol (AQUAVAN)?
Which organ system effect may be observed during pediatric strabismus surgery with propofol anesthesia?
Which organ system effect may be observed during pediatric strabismus surgery with propofol anesthesia?
Which statement about propofol infusion syndrome is true?
Which statement about propofol infusion syndrome is true?
What is a potential effect of propofol on the neuromuscular blockers?
What is a potential effect of propofol on the neuromuscular blockers?
Which organ system effect may be observed with propofol administration in patients with COPD?
Which organ system effect may be observed with propofol administration in patients with COPD?
What is a potential recommendation for handling propofol?
What is a potential recommendation for handling propofol?
What is a potential effect of propofol on pain perception during injection?
What is a potential effect of propofol on pain perception during injection?
Which anesthetic agent is associated with a high incidence of bradycardia?
Which anesthetic agent is associated with a high incidence of bradycardia?
What is the dominant cardiovascular effect of ketamine in a patient with an intact autonomic nervous system?
What is the dominant cardiovascular effect of ketamine in a patient with an intact autonomic nervous system?
What property is NOT included in the ideal anesthetic agent properties?
What property is NOT included in the ideal anesthetic agent properties?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent demonstrates rapid induction and more complete awakening than other induction agents?
Which anesthetic agent demonstrates rapid induction and more complete awakening than other induction agents?
Which of the following is NOT a potential clinical feature of propofol infusion syndrome?
Which of the following is NOT a potential clinical feature of propofol infusion syndrome?
What is a potential effect of propofol on the neuromuscular blockers?
What is a potential effect of propofol on the neuromuscular blockers?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
What is a potential recommendation for handling propofol?
What is a potential recommendation for handling propofol?
Which organ system effect may be observed with propofol administration in patients with COPD?
Which organ system effect may be observed with propofol administration in patients with COPD?
What is a potential effect of propofol on pain perception during injection?
What is a potential effect of propofol on pain perception during injection?
What is a potential disadvantage of fospropofol (AQUAVAN)?
What is a potential disadvantage of fospropofol (AQUAVAN)?
Which drug produces a dissociative state and has intrinsic analgesic properties?
Which drug produces a dissociative state and has intrinsic analgesic properties?
Which statement about fospropofol (AQUAVAN) is true?
Which statement about fospropofol (AQUAVAN) is true?
What property is NOT included in the ideal anesthetic agent properties?
What property is NOT included in the ideal anesthetic agent properties?
Which of the following is a potential dosing range for maintenance of anesthesia with propofol?
Which of the following is a potential dosing range for maintenance of anesthesia with propofol?
What is the recommended dosing for sedation with propofol?
What is the recommended dosing for sedation with propofol?
In which population is a 25-50% reduction in propofol dose recommended?
In which population is a 25-50% reduction in propofol dose recommended?
What is the typical bolus dose for postoperative nausea and vomiting (N/V) in PACU with propofol?
What is the typical bolus dose for postoperative nausea and vomiting (N/V) in PACU with propofol?
What is the dose of propofol recommended for effective treatment of neuraxial opioid-associated pruritis?
What is the dose of propofol recommended for effective treatment of neuraxial opioid-associated pruritis?
What percentage decrease in intraocular pressure can be expected with propofol induction?
What percentage decrease in intraocular pressure can be expected with propofol induction?
Which organ system effect may be observed following propofol administration in patients with COPD?
Which organ system effect may be observed following propofol administration in patients with COPD?
What effect does propofol have on the tachycardic response to hypotension?
What effect does propofol have on the tachycardic response to hypotension?
In which patient population is propofol-induced hypotension more common and exaggerated?
In which patient population is propofol-induced hypotension more common and exaggerated?
What is the approximate reduction in cerebral blood flow (CBF) that can be achieved with propofol?
What is the approximate reduction in cerebral blood flow (CBF) that can be achieved with propofol?
Which induction drug has been shown to provide cerebral protection following incomplete ischemia when titrated to EEG burst suppression?
Which induction drug has been shown to provide cerebral protection following incomplete ischemia when titrated to EEG burst suppression?
What is the potential mechanism underlying the neuroprotective activity of propofol?
What is the potential mechanism underlying the neuroprotective activity of propofol?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent is initially suspended in Cremaphor EL and now provided in an emulsion of propofol, soybean oil, glycerol, and purified egg phosphatide?
Which anesthetic agent is initially suspended in Cremaphor EL and now provided in an emulsion of propofol, soybean oil, glycerol, and purified egg phosphatide?
Which anesthetic agent demonstrates rapid induction and more complete awakening than other induction agents?
Which anesthetic agent demonstrates rapid induction and more complete awakening than other induction agents?
Which anesthetic agent's clearance exceeds hepatic blood flow and is eliminated by the kidneys with a prolonged half-life due to slow release from the peripheral compartment?
Which anesthetic agent's clearance exceeds hepatic blood flow and is eliminated by the kidneys with a prolonged half-life due to slow release from the peripheral compartment?
Which anesthetic agent's pharmacokinetics are best described with a three-compartment model with very high clearance and a slow peripheral compartment?
Which anesthetic agent's pharmacokinetics are best described with a three-compartment model with very high clearance and a slow peripheral compartment?
Which anesthetic agent is associated with a high incidence of bradycardia due to its inhibition of norepinephrine release from the locus coeruleus?
Which anesthetic agent is associated with a high incidence of bradycardia due to its inhibition of norepinephrine release from the locus coeruleus?
What is the dosing range for maintenance of anesthesia with propofol?
What is the dosing range for maintenance of anesthesia with propofol?
Which population requires a 25-50% reduction in propofol dose?
Which population requires a 25-50% reduction in propofol dose?
What is the recommended dosing for sedation with propofol?
What is the recommended dosing for sedation with propofol?
In which condition is propofol as efficacious as ondansetron for reducing postoperative nausea and vomiting?
In which condition is propofol as efficacious as ondansetron for reducing postoperative nausea and vomiting?
What is the effect of propofol on intraocular pressure (IOP)?
What is the effect of propofol on intraocular pressure (IOP)?
What is the mechanism of propofol's anticonvulsant activity?
What is the mechanism of propofol's anticonvulsant activity?
What effect does propofol have on cerebral metabolic rate of oxygen (CMRO2)?
What effect does propofol have on cerebral metabolic rate of oxygen (CMRO2)?
Which organ system is directly affected by propofol-induced hypotension?
Which organ system is directly affected by propofol-induced hypotension?
In which patient population is propofol-induced hypotension more common and exaggerated?
In which patient population is propofol-induced hypotension more common and exaggerated?
What is the primary mechanism behind the cardiovascular effects of propofol?
What is the primary mechanism behind the cardiovascular effects of propofol?
Which benzodiazepine has a slower onset than thiopental or propofol but provides reliable amnesia?
Which benzodiazepine has a slower onset than thiopental or propofol but provides reliable amnesia?
What is the primary route of clearance for midazolam?
What is the primary route of clearance for midazolam?
Which benzodiazepine is insoluble in water and undergoes hepatic oxidative reduction?
Which benzodiazepine is insoluble in water and undergoes hepatic oxidative reduction?
Which benzodiazepine has a lower lipid solubility resulting in delayed onset of CNS effects despite a higher affinity for GABA receptors?
Which benzodiazepine has a lower lipid solubility resulting in delayed onset of CNS effects despite a higher affinity for GABA receptors?
What are the principal pharmacologic effects of benzodiazepines?
What are the principal pharmacologic effects of benzodiazepines?
Which new ultra-short acting benzodiazepine has been submitted for FDA approval and shows a rapid loss of consciousness and a short context-sensitive half-time compared to midazolam?
Which new ultra-short acting benzodiazepine has been submitted for FDA approval and shows a rapid loss of consciousness and a short context-sensitive half-time compared to midazolam?
What is the mechanism of action of etomidate?
What is the mechanism of action of etomidate?
What is the pharmacokinetic characteristic of etomidate?
What is the pharmacokinetic characteristic of etomidate?
What is a clinical use of etomidate?
What is a clinical use of etomidate?
What preparation change has essentially eliminated pain and venous irritation associated with etomidate administration?
What preparation change has essentially eliminated pain and venous irritation associated with etomidate administration?
What is the dominant cardiovascular effect of ketamine in a patient with an intact autonomic nervous system?
What is the dominant cardiovascular effect of ketamine in a patient with an intact autonomic nervous system?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
What is a potential effect of propofol on the neuromuscular blockers?
What is a potential effect of propofol on the neuromuscular blockers?
Which organ system effect may be observed during pediatric strabismus surgery with propofol anesthesia?
Which organ system effect may be observed during pediatric strabismus surgery with propofol anesthesia?
Which of the following is a potential clinical feature of propofol infusion syndrome?
Which of the following is a potential clinical feature of propofol infusion syndrome?
What is a potential recommendation for handling propofol?
What is a potential recommendation for handling propofol?
What is a potential disadvantage of fospropofol (AQUAVAN)?
What is a potential disadvantage of fospropofol (AQUAVAN)?
Which anesthetic agent produces a dissociative state and has intrinsic analgesic properties?
Which anesthetic agent produces a dissociative state and has intrinsic analgesic properties?
What is the primary mechanism behind the cardiovascular effects of propofol?
What is the primary mechanism behind the cardiovascular effects of propofol?
What is a potential effect of propofol on the cardiovascular system?
What is a potential effect of propofol on the cardiovascular system?
What is a potential effect of propofol on the respiratory system?
What is a potential effect of propofol on the respiratory system?
Which statement about fospropofol (AQUAVAN) is true?
Which statement about fospropofol (AQUAVAN) is true?
What is a potential recommendation for handling propofol?
What is a potential recommendation for handling propofol?
Which drug produces the greatest degree of hypotension and apnea among the listed induction agents?
Which drug produces the greatest degree of hypotension and apnea among the listed induction agents?
What is a potential effect of propofol on the tachycardic response to hypotension?
What is a potential effect of propofol on the tachycardic response to hypotension?
What is a potential clinical feature of propofol infusion syndrome?
What is a potential clinical feature of propofol infusion syndrome?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
What is a significant disadvantage to the use of etomidate, particularly as an infusion?
What is a significant disadvantage to the use of etomidate, particularly as an infusion?
What is a potential dosing range for maintenance of anesthesia with propofol?
What is a potential dosing range for maintenance of anesthesia with propofol?
Which organ system effect may be observed with propofol administration in patients with COPD?
Which organ system effect may be observed with propofol administration in patients with COPD?
What is a potential effect of propofol on pain perception during injection?
What is a potential effect of propofol on pain perception during injection?
What is a potential clinical feature associated with fospropofol (AQUAVAN)?
What is a potential clinical feature associated with fospropofol (AQUAVAN)?
What is the mechanism of action of etomidate?
What is the mechanism of action of etomidate?
What is a potential clinical use of etomidate?
What is a potential clinical use of etomidate?
What is a significant disadvantage to the use of propofol?
What is a significant disadvantage to the use of propofol?
What is a potential side effect associated with etomidate administration?
What is a potential side effect associated with etomidate administration?
Which of the following is a potential contraindication for using etomidate as an anesthetic agent?
Which of the following is a potential contraindication for using etomidate as an anesthetic agent?
What is a potential side effect of etomidate that may limit its use in certain patient populations?
What is a potential side effect of etomidate that may limit its use in certain patient populations?
Which of the following is a potential advantage of using etomidate in patients with compromised cardiovascular function?
Which of the following is a potential advantage of using etomidate in patients with compromised cardiovascular function?
Which potential adverse effect limits the use of etomidate in patients with a history of seizure disorder?
Which potential adverse effect limits the use of etomidate in patients with a history of seizure disorder?
What is the primary mechanism of action for benzodiazepines as anesthetic agents?
What is the primary mechanism of action for benzodiazepines as anesthetic agents?
What factor determines the drug effect of benzodiazepines?
What factor determines the drug effect of benzodiazepines?
Which characteristic distinguishes midazolam from other benzodiazepines?
Which characteristic distinguishes midazolam from other benzodiazepines?
What is a potential consequence of midazolam's hepatic oxidative hydroxylation?
What is a potential consequence of midazolam's hepatic oxidative hydroxylation?
What distinguishes methoxycarbonyletomidate (MOC) from etomidate?
What distinguishes methoxycarbonyletomidate (MOC) from etomidate?
What distinguishes carboetomidate from etomidate?
What distinguishes carboetomidate from etomidate?
What distinguishes carboetomidate from methoxycarbonyletomidate (MOC)?
What distinguishes carboetomidate from methoxycarbonyletomidate (MOC)?
Which benzodiazepine has a slower onset than thiopental or propofol but provides reliable amnesia?
Which benzodiazepine has a slower onset than thiopental or propofol but provides reliable amnesia?
What is the primary route of clearance for midazolam?
What is the primary route of clearance for midazolam?
Which benzodiazepine is insoluble in water and undergoes hepatic oxidative reduction?
Which benzodiazepine is insoluble in water and undergoes hepatic oxidative reduction?
What is a potential effect of propofol on the cardiovascular system?
What is a potential effect of propofol on the cardiovascular system?
What is the approximate reduction in cerebral blood flow (CBF) that can be achieved with propofol?
What is the approximate reduction in cerebral blood flow (CBF) that can be achieved with propofol?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane?
Which anesthetic agent is beneficial for patients with compromised cardiovascular status, questionable intravascular volume status, and elevated ICP?
Which anesthetic agent is beneficial for patients with compromised cardiovascular status, questionable intravascular volume status, and elevated ICP?
What effect does etomidate have on steroid synthesis?
What effect does etomidate have on steroid synthesis?
Which side effect is associated with etomidate?
Which side effect is associated with etomidate?
What is the primary mechanism of benzodiazepines' effect on GABAA receptors?
What is the primary mechanism of benzodiazepines' effect on GABAA receptors?
Which benzodiazepine has the highest clearance?
Which benzodiazepine has the highest clearance?
What distinguishes methoxycarbonyletomidate (MOC) from etomidate?
What distinguishes methoxycarbonyletomidate (MOC) from etomidate?
What is the primary route of clearance for midazolam?
What is the primary route of clearance for midazolam?
Which benzodiazepine has a slower onset than thiopental or propofol but provides reliable amnesia?
Which benzodiazepine has a slower onset than thiopental or propofol but provides reliable amnesia?
What distinguishes diazepam from other benzodiazepines in terms of metabolism?
What distinguishes diazepam from other benzodiazepines in terms of metabolism?
What is the mechanism of action of flumazenil?
What is the mechanism of action of flumazenil?
What characteristic distinguishes midazolam from lorazepam and diazepam in terms of metabolism?
What characteristic distinguishes midazolam from lorazepam and diazepam in terms of metabolism?
What are the clinical uses of benzodiazepines?
What are the clinical uses of benzodiazepines?
What are the pharmacologic effects of benzodiazepines?
What are the pharmacologic effects of benzodiazepines?
What distinguishes remimazolam from midazolam?
What distinguishes remimazolam from midazolam?
What is the dosing recommendation for flumazenil for reversal of benzodiazepine effects?
What is the dosing recommendation for flumazenil for reversal of benzodiazepine effects?
What organ system effects are associated with propofol administration?
What organ system effects are associated with propofol administration?
What is the mechanism of action of flumazenil?
What is the mechanism of action of flumazenil?
What is the primary mechanism of action of barbiturates at low concentrations?
What is the primary mechanism of action of barbiturates at low concentrations?
What was the first intravenous barbiturate introduced?
What was the first intravenous barbiturate introduced?
Which barbiturate became the preferred intravenous barbiturate due to its rapid onset, short duration, and lack of excitatory effects?
Which barbiturate became the preferred intravenous barbiturate due to its rapid onset, short duration, and lack of excitatory effects?
Who clinically used thiopental for the first time?
Who clinically used thiopental for the first time?
What is a known use of flumazenil?
What is a known use of flumazenil?
What is a characteristic feature of hexobarbital?
What is a characteristic feature of hexobarbital?
When was thiopental first used clinically?
When was thiopental first used clinically?
What is the recommended dose of droperidol for antiemetic use?
What is the recommended dose of droperidol for antiemetic use?
What is the management approach for central anticholinergic syndrome induced by scopolamine?
What is the management approach for central anticholinergic syndrome induced by scopolamine?
What is the primary current use of droperidol?
What is the primary current use of droperidol?
What is the side effect associated with scopolamine administration that may interfere with drainage of aqueous humor?
What is the side effect associated with scopolamine administration that may interfere with drainage of aqueous humor?
What is the potential treatment for failure of thermoregulatory sweating caused by scopolamine or atropine fever?
What is the potential treatment for failure of thermoregulatory sweating caused by scopolamine or atropine fever?
What are the organ system effects of droperidol in terms of cardiovascular response?
What are the organ system effects of droperidol in terms of cardiovascular response?
What is the mechanism behind the CNS depression caused by droperidol?
What is the mechanism behind the CNS depression caused by droperidol?
What is a potential side effect associated with scopolamine administration that may lead to a wide range of symptoms from restlessness and hallucinations to somnolence and unconsciousness?
What is a potential side effect associated with scopolamine administration that may lead to a wide range of symptoms from restlessness and hallucinations to somnolence and unconsciousness?
What is the primary mechanism of action of dexmedetomidine?
What is the primary mechanism of action of dexmedetomidine?
What is the primary site of analgesic action for dexmedetomidine?
What is the primary site of analgesic action for dexmedetomidine?
What is the half-life of dexmedetomidine?
What is the half-life of dexmedetomidine?
Which receptor does dexmedetomidine primarily agonize to produce hypotension and bradycardia?
Which receptor does dexmedetomidine primarily agonize to produce hypotension and bradycardia?
What is the recommended dosing for pre-procedure sedation with dexmedetomidine intravenously?
What is the recommended dosing for pre-procedure sedation with dexmedetomidine intravenously?
In which setting is dexmedetomidine a very useful tool for sedation during airway management?
In which setting is dexmedetomidine a very useful tool for sedation during airway management?
What is the primary effect of dexmedetomidine when used as an adjunct to general anesthesia?
What is the primary effect of dexmedetomidine when used as an adjunct to general anesthesia?
Which receptor does dexmedetomidine primarily agonize to produce vasoconstriction in the cerebral vessels?
Which receptor does dexmedetomidine primarily agonize to produce vasoconstriction in the cerebral vessels?
What is the primary effect of dexmedetomidine on the neuroendocrine stress response to surgery?
What is the primary effect of dexmedetomidine on the neuroendocrine stress response to surgery?
What is the renal effect of dexmedetomidine?
What is the renal effect of dexmedetomidine?
What is the most common subtype of porphyria?
What is the most common subtype of porphyria?
Which drug is NOT listed as a potential trigger for porphyria?
Which drug is NOT listed as a potential trigger for porphyria?
What is the primary mechanism of action for ketamine?
What is the primary mechanism of action for ketamine?
Which isomer of ketamine has approximately 4 times greater affinity for the phencyclidine binding site on NMDA receptor than the other?
Which isomer of ketamine has approximately 4 times greater affinity for the phencyclidine binding site on NMDA receptor than the other?
What effect may be observed with chronic dosing of ketamine?
What effect may be observed with chronic dosing of ketamine?
What is a potential clinical use of ketamine at sub-anesthetic doses?
What is a potential clinical use of ketamine at sub-anesthetic doses?
What organ system effect may be observed with ketamine use?
What organ system effect may be observed with ketamine use?
What is the primary route of clearance for ketamine?
What is the primary route of clearance for ketamine?
What is a potential side effect associated with ketamine use?
What is a potential side effect associated with ketamine use?
What preparation is ketamine supplied in?
What preparation is ketamine supplied in?
Which receptor type does ketamine act as an antagonist at?
Which receptor type does ketamine act as an antagonist at?
What is the approximate duration of action for thiopental?
What is the approximate duration of action for thiopental?
What is the primary route of clearance for barbiturates like thiopental?
What is the primary route of clearance for barbiturates like thiopental?
Which effect has been observed at lower doses of methohexital in patients with existing seizure disorders?
Which effect has been observed at lower doses of methohexital in patients with existing seizure disorders?
What is the approximate percentage decrease in cerebral metabolic rate of oxygen (CMRO2) achievable with barbiturates?
What is the approximate percentage decrease in cerebral metabolic rate of oxygen (CMRO2) achievable with barbiturates?
Which cardiovascular effect is typically observed with barbiturates like thiopental?
Which cardiovascular effect is typically observed with barbiturates like thiopental?
What is a potential respiratory effect of barbiturate induction?
What is a potential respiratory effect of barbiturate induction?
Which receptor does ketamine primarily act on to induce sedation and hypnosis?
Which receptor does ketamine primarily act on to induce sedation and hypnosis?
What is the approximate duration of action following a single induction dose of ketamine?
What is the approximate duration of action following a single induction dose of ketamine?
Which organ system effect may be observed with ketamine administration?
Which organ system effect may be observed with ketamine administration?
What is the primary mechanism behind the cardiovascular effects of dexmedetomidine?
What is the primary mechanism behind the cardiovascular effects of dexmedetomidine?
What is the primary route of clearance for dexmedetomidine?
What is the primary route of clearance for dexmedetomidine?
Which organ system effect may be observed with dexmedetomidine administration?
Which organ system effect may be observed with dexmedetomidine administration?
What is a potential clinical use of dexmedetomidine?
What is a potential clinical use of dexmedetomidine?
What are the potential side effects associated with ketamine use?
What are the potential side effects associated with ketamine use?
Which effect is NOT primarily associated with alpha-2A receptor stimulation by dexmedetomidine?
Which effect is NOT primarily associated with alpha-2A receptor stimulation by dexmedetomidine?
What are the potential CNS effects associated with ketamine use?
What are the potential CNS effects associated with ketamine use?
What is a potential concern when using ketamine for induction in patients with known coronary artery disease?
What is a potential concern when using ketamine for induction in patients with known coronary artery disease?
Which of the following is a potential trigger for Acute Intermittent Porphyria?
Which of the following is a potential trigger for Acute Intermittent Porphyria?
What are the primary symptoms of porphyria?
What are the primary symptoms of porphyria?
Which sedative/hypnotic has a rapid onset of action and high lipid solubility?
Which sedative/hypnotic has a rapid onset of action and high lipid solubility?
Which ketamine isomer has greater affinity for the phencyclidine binding site on the NMDA receptor?
Which ketamine isomer has greater affinity for the phencyclidine binding site on the NMDA receptor?
What is the active metabolite produced when ketamine is metabolized by hepatic microsomal enzymes?
What is the active metabolite produced when ketamine is metabolized by hepatic microsomal enzymes?
Which receptor does ketamine affect in addition to NMDA receptors?
Which receptor does ketamine affect in addition to NMDA receptors?
What is a potential clinical use of ketamine at sub-anesthetic doses?
What is a potential clinical use of ketamine at sub-anesthetic doses?
What are some contraindications for barbiturates?
What are some contraindications for barbiturates?
What are some side effects associated with barbiturates?
What are some side effects associated with barbiturates?
What are some uses of barbiturates other than sedation?
What are some uses of barbiturates other than sedation?
Which of these drugs is a non-GABA agonist sedative/hypnotic?
Which of these drugs is a non-GABA agonist sedative/hypnotic?
Which of the following is a potential side effect of etomidate?
Which of the following is a potential side effect of etomidate?
What is a potential benefit of using etomidate in patients with compromised cardiovascular function?
What is a potential benefit of using etomidate in patients with compromised cardiovascular function?
What is a potential limitation for using etomidate in patients with a history of seizure disorder?
What is a potential limitation for using etomidate in patients with a history of seizure disorder?
Which anesthetic agent has a much greater potency in inhibiting steroid synthesis than as a sedative-hypnotic?
Which anesthetic agent has a much greater potency in inhibiting steroid synthesis than as a sedative-hypnotic?
What distinguishes methoxycarbonyletomidate (MOC) from etomidate?
What distinguishes methoxycarbonyletomidate (MOC) from etomidate?
What characteristic distinguishes midazolam from lorazepam and diazepam in terms of metabolism?
What characteristic distinguishes midazolam from lorazepam and diazepam in terms of metabolism?
What is the primary mechanism of action for benzodiazepines as anesthetic agents?
What is the primary mechanism of action for benzodiazepines as anesthetic agents?
What is a potential dosing range for maintenance of anesthesia with propofol?
What is a potential dosing range for maintenance of anesthesia with propofol?
What is the primary current use of droperidol?
What is the primary current use of droperidol?
What is the approximate duration of amnesia and disorientation following return of consciousness caused by ketamine?
What is the approximate duration of amnesia and disorientation following return of consciousness caused by ketamine?
Which of the following is a potential side effect of ketamine's cardiovascular effects?
Which of the following is a potential side effect of ketamine's cardiovascular effects?
What is the primary mechanism of action of dexmedetomidine?
What is the primary mechanism of action of dexmedetomidine?
What is a potential side effect of ketamine's respiratory effects?
What is a potential side effect of ketamine's respiratory effects?
What is the dosing range for ketamine used for induction of anesthesia?
What is the dosing range for ketamine used for induction of anesthesia?
Which personality type may be more susceptible to emergence reactions caused by ketamine?
Which personality type may be more susceptible to emergence reactions caused by ketamine?
What are the indications for ketamine induction?
What are the indications for ketamine induction?
What is the primary effect of ketamine on cerebral metabolic rate of oxygen consumption (CMRO2)?
What is the primary effect of ketamine on cerebral metabolic rate of oxygen consumption (CMRO2)?
Which receptor does dexmedetomidine primarily agonize to produce sympatholysis?
Which receptor does dexmedetomidine primarily agonize to produce sympatholysis?
What are the clinical uses of ketamine?
What are the clinical uses of ketamine?
What is a potential side effect associated with ketamine administration?
What is a potential side effect associated with ketamine administration?
What distinguishes dexmedetomidine from medetomidine?
What distinguishes dexmedetomidine from medetomidine?
Study Notes
Anesthetic Agents: Properties, Mechanisms, and Clinical Uses
- Ketamine's dominant cardiovascular effect in a patient with an intact autonomic nervous system is hypertension and tachycardia
- Dexmedetomidine inhibits release of norepinephrine from the locus coeruleus and is associated with a high incidence of bradycardia
- Ideal anesthetic agent properties include drug compatibility, lack of pain on injection, rapid onset of hypnosis, and absence of postoperative complications
- Most commonly used induction agents include propofol, etomidate, ketamine, and barbiturates
- GABA agonist sedative-hypnotics include propofol, etomidate, benzodiazepines, and barbiturates
- Propofol's mechanism of action involves increasing duration of GABA-activated opening of chloride channels and hyperpolarizing the postsynaptic cell membrane
- Propofol is initially suspended in Cremaphor EL and now provided in an emulsion of propofol, soybean oil, glycerol, and purified egg phosphatide
- Propofol decreases the rate of dissociation of GABA from the GABAA receptor and increases the duration of GABA-activated opening of chloride channels
- Propofol's clearance exceeds hepatic blood flow and it is eliminated by the kidneys with a prolonged half-life due to slow release from the peripheral compartment
- Propofol's pharmacokinetics are best described with a three-compartment model with very high clearance and a slow peripheral compartment
- Clinical uses of propofol include rapid induction of anesthesia with dosing in healthy adults at 1.5-2.5 mg/kg for unconsciousness at 2-6 μg/ml
- Propofol demonstrates rapid induction and more complete awakening than other induction agents
Benzodiazepines: Pharmacokinetics and Clinical Uses
- Midazolam has a rapid metabolism via hepatic oxidative hydroxylation and is primarily cleared by the kidneys, with potential accumulation in renal insufficiency.
- Presence of drugs inhibiting cytochrome P-450 can delay midazolam metabolism, and its hepatic clearance is significantly greater than that of diazepam and lorazepam.
- Diazepam is insoluble in water, so it is dissolved in organic solvents, and it undergoes hepatic oxidative reduction, with prolonged elimination half-time in cirrhosis due to decreased protein binding and hepatic blood flow.
- Lorazepam is metabolized via hepatic glucuronidation to inactive metabolites, and its lower lipid solubility results in delayed onset of CNS effects despite a higher affinity for GABA receptors.
- Benzodiazepines are clinically used for preoperative anxiolysis, IV sedation, induction and maintenance, and other uses such as termination of seizure activity and management of delirium tremens.
- Midazolam dosing guidelines recommend 0.05-0.15 mg/kg for induction and 0.05 mg/kg maintenance, while lorazepam and diazepam have different dosing ranges for various indications.
- Midazolam has a slower onset than thiopental or propofol but provides reliable amnesia, and its dose and onset are affected by premedication, anesthetic agents, ASA classification, and patient characteristics.
- Benzodiazepines have five principal pharmacologic effects: anxiolysis, sedation, anticonvulsant, skeletal muscle relaxation, and amnesia.
- Benzodiazepines have organ system effects on the CNS, cardiovascular, respiratory, and musculoskeletal systems, with implications for intracranial compliance, seizure management, blood pressure, and respiratory depression.
- Remimazolam, a new ultra-short acting benzodiazepine, has been submitted for FDA approval and shows a rapid loss of consciousness and a short context-sensitive half-time compared to midazolam.
- Flumazenil is a benzodiazepine receptor ligand with high receptor affinity, minimal intrinsic effect, and rapid clearance by hepatic microsomal enzymes, used for reversal of residual benzodiazepine-induced sedation and suspected benzodiazepine overdose.
- Flumazenil is administered incrementally to a total dose of 3.0 mg for reversal of benzodiazepine effects, as it prevents or reverses all effects of other benzodiazepines in a dose-dependent manner.
Benzodiazepines: Pharmacokinetics and Clinical Uses
- Midazolam has a rapid metabolism via hepatic oxidative hydroxylation and is primarily cleared by the kidneys, with potential accumulation in renal insufficiency.
- Presence of drugs inhibiting cytochrome P-450 can delay midazolam metabolism, and its hepatic clearance is significantly greater than that of diazepam and lorazepam.
- Diazepam is insoluble in water, so it is dissolved in organic solvents, and it undergoes hepatic oxidative reduction, with prolonged elimination half-time in cirrhosis due to decreased protein binding and hepatic blood flow.
- Lorazepam is metabolized via hepatic glucuronidation to inactive metabolites, and its lower lipid solubility results in delayed onset of CNS effects despite a higher affinity for GABA receptors.
- Benzodiazepines are clinically used for preoperative anxiolysis, IV sedation, induction and maintenance, and other uses such as termination of seizure activity and management of delirium tremens.
- Midazolam dosing guidelines recommend 0.05-0.15 mg/kg for induction and 0.05 mg/kg maintenance, while lorazepam and diazepam have different dosing ranges for various indications.
- Midazolam has a slower onset than thiopental or propofol but provides reliable amnesia, and its dose and onset are affected by premedication, anesthetic agents, ASA classification, and patient characteristics.
- Benzodiazepines have five principal pharmacologic effects: anxiolysis, sedation, anticonvulsant, skeletal muscle relaxation, and amnesia.
- Benzodiazepines have organ system effects on the CNS, cardiovascular, respiratory, and musculoskeletal systems, with implications for intracranial compliance, seizure management, blood pressure, and respiratory depression.
- Remimazolam, a new ultra-short acting benzodiazepine, has been submitted for FDA approval and shows a rapid loss of consciousness and a short context-sensitive half-time compared to midazolam.
- Flumazenil is a benzodiazepine receptor ligand with high receptor affinity, minimal intrinsic effect, and rapid clearance by hepatic microsomal enzymes, used for reversal of residual benzodiazepine-induced sedation and suspected benzodiazepine overdose.
- Flumazenil is administered incrementally to a total dose of 3.0 mg for reversal of benzodiazepine effects, as it prevents or reverses all effects of other benzodiazepines in a dose-dependent manner.
Benzodiazepines: Pharmacokinetics and Clinical Uses
- Midazolam has a rapid metabolism via hepatic oxidative hydroxylation and is primarily cleared by the kidneys, with potential accumulation in renal insufficiency.
- Presence of drugs inhibiting cytochrome P-450 can delay midazolam metabolism, and its hepatic clearance is significantly greater than that of diazepam and lorazepam.
- Diazepam is insoluble in water, so it is dissolved in organic solvents, and it undergoes hepatic oxidative reduction, with prolonged elimination half-time in cirrhosis due to decreased protein binding and hepatic blood flow.
- Lorazepam is metabolized via hepatic glucuronidation to inactive metabolites, and its lower lipid solubility results in delayed onset of CNS effects despite a higher affinity for GABA receptors.
- Benzodiazepines are clinically used for preoperative anxiolysis, IV sedation, induction and maintenance, and other uses such as termination of seizure activity and management of delirium tremens.
- Midazolam dosing guidelines recommend 0.05-0.15 mg/kg for induction and 0.05 mg/kg maintenance, while lorazepam and diazepam have different dosing ranges for various indications.
- Midazolam has a slower onset than thiopental or propofol but provides reliable amnesia, and its dose and onset are affected by premedication, anesthetic agents, ASA classification, and patient characteristics.
- Benzodiazepines have five principal pharmacologic effects: anxiolysis, sedation, anticonvulsant, skeletal muscle relaxation, and amnesia.
- Benzodiazepines have organ system effects on the CNS, cardiovascular, respiratory, and musculoskeletal systems, with implications for intracranial compliance, seizure management, blood pressure, and respiratory depression.
- Remimazolam, a new ultra-short acting benzodiazepine, has been submitted for FDA approval and shows a rapid loss of consciousness and a short context-sensitive half-time compared to midazolam.
- Flumazenil is a benzodiazepine receptor ligand with high receptor affinity, minimal intrinsic effect, and rapid clearance by hepatic microsomal enzymes, used for reversal of residual benzodiazepine-induced sedation and suspected benzodiazepine overdose.
- Flumazenil is administered incrementally to a total dose of 3.0 mg for reversal of benzodiazepine effects, as it prevents or reverses all effects of other benzodiazepines in a dose-dependent manner.
Intravenous Anesthetic Agents: Etomidate and Benzodiazepines
- Etomidate has a dosage of 4 mg/kg and is beneficial for patients with compromised cardiovascular status, questionable intravascular volume status, elevated ICP, electroconvulsive therapy, mapping of epileptogenic foci, and maintenance of anesthesia.
- Etomidate may not be suitable for patients with a history of seizure disorder due to its activation of epileptogenic foci and amplification of SSEP signal.
- Etomidate has minimal effects on the sympathetic nervous system and baroreceptor function, making it useful in patients with poor cardiovascular function and settings where any reduction in blood pressure may be significant.
- Etomidate induces less depression of ventilation compared to other induction agents and is safe to use in patients with reactive airways disease.
- Etomidate has a much greater potency (20x) in inhibiting steroid synthesis than as a sedative-hypnotic, leading to suppression of adrenal steroidogenesis and cortisol production for up to 72 hours.
- Side effects of etomidate include excitatory activity, myoclonus, pain on injection, and high incidence of postoperative nausea and vomiting (PONV).
- Methoxycarbonyletomidate (MOC) and carboetomidate are potential etomidate derivatives with similar hypnotic potency and reduced adrenal suppression.
- Midazolam, a benzodiazepine, has a unique structure with a substituted imidazole ring and is lipid-soluble.
- Benzodiazepines enhance the affinity of the GABAA receptors for GABA, resulting in increased chloride conductance and hyperpolarization of the postsynaptic cell membrane.
- The drug effect of benzodiazepines is a function of receptor occupancy, with less than 20% occupancy leading to anxiolysis and over 60% leading to unconsciousness.
- Benzodiazepines are highly protein bound, with Lorazepam having slightly greater volume of distribution despite lower lipid solubility, and Midazolam having the highest clearance.
- Midazolam undergoes hepatic oxidative hydroxylation and has a rapid onset, short duration, and high hepatic clearance, with prolonged elimination in the elderly due to decreased hepatic blood flow and enzyme activity.
Ketamine and Dexmedetomidine: Pharmacology and Clinical Uses
- Ketamine dosed at 1-3 μg/kg/min IV infusion for postoperative sedation and analgesia
- Ketamine used for induction of anesthesia with dosing at 1-2 mg/kg IV and 4-8 mg/kg IM
- Indications for ketamine induction include hemodynamic instability, active bronchospasm, and lack of IV access
- Ketamine may produce amnesia and disorientation for 60-90 minutes following return of consciousness
- Ketamine's effects on the CNS include functional disorganization of midbrain and thalamic pathways
- Ketamine is associated with increased cerebral metabolic rate of oxygen consumption (CMRO2) and intracranial pressure (ICP)
- Ketamine may lead to emergence reactions in 10-30% of adults, with certain personality types being more susceptible
- Ketamine's cardiovascular effects include increased systemic blood pressure and heart rate
- Ketamine has minimal effect on respiratory drive and may cause increased salivation and bronchodilation
- Side effects of ketamine include emergence delirium and inhibition of platelet aggregation
- Dexmedetomidine is the S-enantiomer of medetomidine, a highly specific α2 receptor agonist
- Dexmedetomidine's mechanism of action includes sedation, sympatholysis, analgesia, and neuroprotection through α2 receptor agonism
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Test your knowledge of anesthesia dosing variables with this quiz. Explore how different factors such as age, weight, and gender can impact the dosing of anesthesia for maintaining anesthesia and achieving rapid awakening.
