-
nitrous oxide
- inhalation agent
- vaporized @ RT
- potent
- low solubility in blood
- minimally metabolized
- depth of anesthesia depends on partial pressure in the brain
- high MAC (104%) - limited as a single agent so used in conjunction with other volatiles
-
isoflurane, sevoflurane, and desflurane
- inhalation agent
- vaporized @ RT
- potent
- low solubility in blood
- minimally metabolized
- depth of anesthesia depends on partial pressure in the brain
- isoflurane has highest blood-gas partition coeff, oil-gas partition coeff, and thus highest MAC
-
propofol
- induction agent, can be used in procedural sedation
- 2,6-diisopropylphenol - potentiation of GABAa receptor
- emulsion containing soybean oil, glycerol, and egg lecithin
- rapid onset, short duration, less hangover
- rapid hepatic metabolism (can be used as infusion)
- adverse effects: hypotension, profound respiratory depressant
-
thiopental
- barbiturate, can be used in procedural sedation
- potentiation of GABAa receptor
- sulfur atom increases lipid solubility; higher potency, shorter onset and duration
- rapid onset, short duration
- long elimination half-life (cannot be used as infusion)
- adverse effects: hypotension and tachycardia, upper airway obstruction and apnea
- barbiturates are sometimes used for reducing cerebral oxygen demand or reducing intracranial pressure
-
etomidate
- potentiates GABAa receptor, can be used in procedural sedation
- pain on injection
- rapid onset, rapid redistribution
- most CARDIO-STABLE of IV induction agents
- ventilation less affected than other agents
- adverse effects: adrenocortical suppression, myoclonus
-
ketamine
- NMDA antagonist, can be used in procedural sedation
- dissociative anesthesia - sensory impulses dissociated from awareness
- - patient may appear to be conscious yet unable to process or respond to sensory input
- mild analgesic, amnestic
- commonly administered IV or IM
- central stimulation of sympathetic nervous system
- beneficial in hypovolemic shock; ventilatory drive is minimally affected
- adverse effects: hallucinations, disturbing dreams, delirium (can be prevented with benzos)
-
midazolam
- benzodiazepine, can be used in procedural sedation
- potentiates action of GABA at GABAa receptor
- most commonly used benzodiazepine
- used as premedication and for procedural sedation
- produce sedation and amnesia, but potent respiratory depressant
- antagonized by flumazenil
-
procaine
- local anesthetic ester
- 14-18min onset
- metabolized rapidly (plasma cholinesterase), less systemic toxicity
-
bupivacaine
- local anesthetic amide
- 5-8min onset
- metabolized slowly (hepatic carboxyesterase), more likely vs ester to have systemic toxicity
- higher lipid solubility vs lidocaine = longer duration of action and higher potency, but also increases toxicity
-
lidocaine
- local anesthetic amide
- 2-4 min onset
- metabolized slowly (hepatic carboxyesterase), more likely vs ester to have systemic toxicity
-
dexmedetomidine
α2 agonist, can be used in procedural sedation
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