-
Advantages of Propofol (4):
- Rapid Induction
- Rapid Metab
- Non-cumulative (CRI)
- Smooth Recovery, w/o hangover
-
Disadvantages of Propofol(6):
- Cardiovascular Depressant
- Respiratory Depressant
- Supports Bacterial Growth
- Pain on Inj (occasional)
- Twitching/jerking (esp w/o premed)
- Shakes
-
Alfaxalone is categorized as a....
Pregnanedione steroidal anesthetic agent
-
Alfaxaan...
Onset:
Duration:
Protein Binding:
Recovery:
- Onset: Slower than porpfol
- Duration: Short
- Protein Binding: Moderate 50%
- Recovery: Rapid
-
Which drugs don't cause irritation if inj para-vascularly?
-
Alfaxaan CNS Fx:
Binds to central GABAa receptors
-
Alfaxaan Repiratory Fx:
- Mild
- Decreased Tidal volume and RR
- Apnea (if inj too rapidly)
-
Alfaxaan Cardio Fx:
Similiar to Propofol, Dose dep
-
Advantages of Alfaxaan over Saffan (older prep)(4):
- No histamine Release
- Dogs and Cats
- Rapid Recovery
- IV (also IM in cats)
-
Advantages of Alfaxalone (5):
- Rapid Induction/Recovery
- Rapid Metab
- Non-cumulative
- Admin IV or IM
- Less Respiratory Depression than propofol or thiopental
-
Disadvantages of Alfaxalone (3):
- Anaphylaxis in cats
- Poor recovery w/ hypersensitivity/paddling/muscle tremors
- IM requires large volume
-
-
What Fx does Ketamine produce(3)?
- Amnesia
- Analgesia
- Unconsciousness
-
Ketamine is often used with:
- Benzodiazapines
- ACP
- Alpha 2 Agonists
-
___% Ketamine has a pH of ___, so it stings IV and IM
-
What do the new formulations of Ketamine consist of?
- S Ketamine
- (Racemic used in Vet Med)
-
What properties allow Ketamine to rapidly cross the BBB (3)?
- Low MW
- High Lipid Solubility
- pKa ~physiological pH
-
Ketamine: Plasma Protein Binding?
Less Protein Binding -> OD in hypoproteinemic P's
-
Ketamine: Induction speed?
Slow (30 sec)
-
Active Metabolites of Ketamine:
Nor-ketamine
-
Excretion of Ketamine:
- Ketamine- Unchanged in urine
- Nor-Ketamine- Kidneys
-
What is Ketamine's primary site for anesthetic action? What Fx does this produce?
- Thalamoneocortical Projection System=
- DEPRESSES Cortex & Thalamus and STIMULATES the Limbic Sys (hippocampus)
- Functional Disorganization of the thalamus and limbic cortex
-
CNS side fx of Ketamine (3):
- Thalamoneocortical Projection
- Emergence Phenomena (hallucination, out of body, dreams, etc)
- Increased salivation (espc in cats and pigs- Tx with anticholinergic)
- Blocks polysynaptic Reflexes in spinal cord
- Blocks medial Reticular Formation (nociception to brain)
-
Ketamine Neurotransmitters in CNS (6):
- NMDA Antag
- Excitatory glutamate
- Cholinergic receptor inhibition
- Opioid Receptor agonism
- Blocks Norepi
- Interacts w/ GABAa
-
Ketamine is a bad choice for...(4)
- Head Trauma P
- Neurosurgery P
- Ocular Sx P
- Cardiovascular Dz P
-
Why is Ketamine a bad choice for Head Trauma & Neurosurgery P's (7)?
- Increases CMRO2
- Increases CBF
- Increases ICP
- Myoclonic Activity
- Seizures
- Congestive Heart Failure
- Severe Hypoertension
-
Ketmamine is never given alone d/t...
- Myoclonus
- Poor Muscle Relaxant
- Unpleasant Dreams
- Emergence Reactions
-
What drugs are often given w/ Ketamine(6)?
- Bezodiazopines
- Opioid
- Guaiphenesin
- Ace
- Alpha 2 Agonist
- +/- Anticholinergic for salivation
-
D/T Ketamine's Myoclonic Activities, is should always be given with....
A drug w/ muscle relaxant activities
-
Why is Ketamine a bad choice for ocular Sx P's?
- Increases Intra-ocular P
- Dilated, centrally fixed pupils
- Nystagmus (esp horses)
- Corneal Reflexes present
- Eyelids remain open
-
What drug requires the use of eye lube?
Ketamine
-
Ketamine CVS Fx:
- Increased BP
- Increased HR
- Increased CO
-
How does Ketamine cause stimulation of the CVS?
- Stimulation of Sympathetic NS
- Inhibition of Norepinephrine uptake
-
Specifically, how does Ketamine induce stress on the CVS (3)?
- Increases Pulmonary Arterial P
- Increases Myocardial work
- Also had myocardial depressant effect
-
Price doesn't use Ketamine in dogs, unless...
they can be heavily sedated during recovery
-
Price doesn't use Ketamine in dogs, unless...
prolonged inhalational anesthesia
-
Ketamine is often used for...
- Horses
- Darting wild animals
-
While monitering a P under ketamine anesthesia, it is important to consider
Cranial nerver and other relflexes will be different than other anesthetic techniques
-
Contraindications to Ketamine (9):
- Head Trauma/Neuro Sx
- Sole Anesthetic for visceral surgery
- Glaucoma
- CVS Dz (HCM, Valvular Stenosis, CHF)
- Hyperthyroid cats
- Hepatic Dz
- Renal Dz
- Urinary obs
- Epileptic/myelography
-
Advantages of Ketamine (5):
- Minmal CVS Depression
- Minimal Respiratory Depression
- Anti-hyperalgesic Effect
- Wide Safety Margin
- Wide range of Species
-
Disadvantages of Ketamine (10):
- Tachycardia
- Salivation
- Painful IM or SQ
- Poor m relaxant
- Corneal relaxant
- Slow recovery
- Emergence Rxns (excitement, euphoria, confusion, fear)
- Increased Intraocular P
- Increased Intracranial P
- Seizures
-
Telazol/Zoletil is a combo of:
Tiletamine and Zolazopam (which is a benzodiazapine)
-
What effects do the Telazol components have?
- Tiletamine: cataleptic/dissociative Agent
- Zolazopam: sedatoin, hypnosis, muscle relaxation, anxiolysis and sedation
-
In dogs and cats, the recovery from telazol is characterized as...
- Long
- Rough
- Poss convulsions
- Esp violent/noisy in dogs b/c Tiletamins outlasts Zolazapam
-
Telazol combined with an Alpha 2 is commonly used in ___
pigs
-
Contraindications of effects of Telazol/Zoletil (12):
- Severe Cardiac or Respiratory compromised animals
- Pancreatic Deficiency
- (rest are similar to Ketamine)
- Head Trauma/Neuro Sx
- Sole Anesthetic for visceral surgery
- Glaucoma
- CVS Dz (HCM, Valvular Stenosis, CHF)
- Hyperthyroid cats
- Hepatic Dz
- Renal Dz
- Urinary obs
- Epileptic/myelography
-
Etomidate...
Protein Binding:
Onset:
Recovery D/T:
Elimination 1/2 Life:
Clearance:
Duration of Action:
- Protein Binding: Highly
- Onset: Rapid
- Recovery D/T: Redistribution
- Elimination 1/2 Life: Short
- Clearance: Rapid
- Duration of Action: Linearly related to dose
-
The Rapid Elimination and Clearance rate of Etomidate, allow for....
Single or Mult doses, or CRI
-
Etomidate is metabolized by ____
the liver
-
Etomidate CVS Fx:
- Minimal Fx
- No Contractility, CO, no histamine, minimal sympathetic and baroreceptor)
-
Etomidate Respiratory Fx:
-
Etomidate Endocrine Fx:
Temporary Suppression of Adrenocortical Function
-
Adverse Fx of Etomidate(3):
- Pain on injection
- Phlebitis
- Unpleasant Myoconus on Injection
- (Hiccups, nausea, vomiting, retching, and sneezing in Humans)
-
What is given with Etomidate?
- Ace/Benzodiezapine/opioid
- (heavy sedation before or with)
-
Etomidate is reserved for P with (6):
- Cardiovascular Dz
- Haemodynamically unstable P
- Trauma P
- P w/ severe systemic diseases, including liver dz
- Caesarean section
- Neuro Sx
-
Advantages of etomidate (4):
- Min CVS/Resp depression
- Rapid Onset/Recovery
- Can be admin as CRI
- Cerebral Protection in animals with brain Dz or injury
-
Disadvantages of etomidate (6):
- Expensive
- Painful
- No analgesia
- Violent recovery
- Temp supression of Adrenal Gland
- Vomiting
-
Which drug has adverse endocrine effects?
Etomidate
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