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ULTRA SHORT BARBITURATES
THIOPENTAL, THIAMYLAL, METHOHEXITAL
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WHY AND WHAT ARE BARBIT INCOMPATIBLE?
DT HIGH ACIDICITY THEY DON'T WORK WITH OPIOIDS, CATECHOLAMINES, AND NMB
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OXYBARBIT VS THIOBARBIT
THIO ARE MORE LIPID, HIGER POTENCY, FASTER ONSET, SHORTER DURATION.
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WHERE DOES BARBIT WORK AT
AT THE GABA RECEPTOR THAT ACITIVATES THE CHLORIDE CHANNES TO OPEN MAKE THE MEMBRANE HYPERPOLARIZED
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LEAN BODY WEIGHT
- MALE- 60 + (2.3X INCH OVER60)
- FEMALE 45.5 + "" "" "" ''' ''
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METABOLISM OF THIOPENTAL VS METHOHEXITAL
THIO IS ENZYME DEPENDANT AND METH IS BLOOD FLOW DEPENDANT.
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ONLY BARBIT THAT IS RENAL EXCRETION
PHENOBARITAL
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CLINICAL USES OF BARBIT
- DECREASE ICP
- INDUCTIONS
- TX HYPERBILIRU AND KERNINCTERUS WITH PHENO
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DISADVAN OF METHOHEXITAL
MYOLONUS, HICCOUGH, 33% SEIZURES,
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HOW DOES BARBIT TX INCREASE ICP
- WITH DUIRESIS AND HYPERVENT
- DECRE BRAIN BLOOD FLOW, AND INDUCE CEREBO VASOCONCTRICTION, O2 NEED,
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SE OF BARBIT
- LOW BP,
- HEART DEPRESSION
- HISTAMIN RELEASE
- NOT FOR LOW VOL PT
- RESP DEPRESSION
- NO THIOPENTAL FOR INTERMITTENT PUR
- ACUTE TOLERANCE
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ANAPHYLACTIOD REACTION
NOT A TRUE REACTION (IMMUNE) BUT STILL HAVE HISTAMINE RELEASE, VASO DILUATION, WHEALS, WELTS.
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PROPOFOL NERUO AND EYE
- ANTICONVULSANT
- DECREASE CERE METABOLIC, ICP, BLOOD FLOW
DECREASE IOP,
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PROPOFOL CARDIO AND LUNGS
- DECREASE IN BP (AVOID WITH LOW VOL)
- MAY CAUSE PROFOUND LOW HR
VENT DEPRESSION
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ETOMIDATE CNS AND LUNG
- DECREASE ICP
- CAUTION WITH FOCAL SEIZURES
VENT DEPRESSION
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ETOMIDATE CARDIO, RENAL
- MINIMAL CHANGES TO HR, SV, CO
- CAUTION WITH LOW VOL
MINIMAL EFFECTS ON RENAL BF
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ETOMIDATE SE
- MYOCLONUS, HICCOUGHS
- ADRENOCORTICAL SUPPRESSION
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HOW IS KETAMINE UNLIKE OTHER MEDICATION
- WORKS ON NMDA NOT GABA
- INTENSE ANALGESIA
- CARDIO STIMULANT
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EMERGENCE DELIRUM WITH KETAMINE
CAN PREVENT WITH VERSED 5 MIN A
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