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Propofol (Diprivan)
- - Induction 15-30 sec
- - give slow d/t vessel irritant
- - awake time faster than other IV induction agents
- - < hangover effect
- - antiemetic, antipruitic and anticonvulsant
- - Duration 5-10 min
- - 1/2 life 2-3 hrs
- - liver and renal disease don't effect elimination
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S/E of propofol
- - Bradycardia, pain, hypertriglyceridemia
- - allergic reaction (soybean & egge lecithin- proteins in egg whites)
- - lactic acidosis
- - decreased BP d/t decreased CO and SVR
- - depresses ventilation
-
Etomidate (Amidate)
- - weak base
- - 99% unionized at physiologic pH
- - Vd large (tissue distribution)
- - reaches peak brain levels w/in 1 min
- - rapid recovery d/t rapid redistribution & metabolism (by plasma esterases & hepatic P-450)
- - emergence 5-10 min
- - 1/2 life 2-5 hrs
-
Etomidate S/E
- - minimal cardio effects
- - < resp depression (occasional apnea on rapid admin
- - > incidence of myoclonus on rapid IV induction
- - adenocortical supression (> risk of sepsis and bleeding)
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Dexmetomidine (Precedex)
- - alpha 2 agonist
- - use: control of stress, anxiety or pain
- - Vd 118 L
- - 1/2 life = 2 hrs
- - metabolism = mainly via glucoronidation and P-450
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Midazolam (Versed)
- - benzo w/ strong hypnotic activities
- - duration 15 min
- - good amnesic
- - minimal cardio effects
-
Ketamine (Ketalar)
- - rapid induction
- - duration 15 min
- - metabolism by N-demethylated (P450) to norketamine, then by hydoxylation (P450) to hydroxynorketamine (inactive)
- - glucoronated and excreted inurine
-
Ketamine S/E
- - stimulates CNS. increases HR, CO & BP-good analgesic and amnesic
- - blocks glutamate excitatory NMDA receptors in CNS
- - triggers catalepsy (dissociative anesthesia
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