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INHALATION AGENTS: all are halogenated ethers except Nitrous;

All depress except Nitrous:


CNS Depression: decreased IOP, CMRO2, increased ICP
Cardiac Depression: Decreased B/P, HR
SVR: decreased
Baroreceptors: decreased (carotid/ aorta)
Hormonal Changes: decreased renin/vasopressin
Anesthetic Agent MAC Blood/Gas Coefficient Oil/Gas Coefficient Other
Desflurane 5.8 0.42 18.7 resp irritation, increase
(Suprane) ICP, decrease CMRO2 &
IOP
Nitrous Oxide 105 0.47 1.4 Analgesic effect
Sevoflurane 2 0.6 50 Contrindicated w/ renal
(Altane) pts-5-8% metabolized;
Compound A- sodalyme
Isoflurane 1.15 1.4 99 Tachycardia, resp. irritant
(Forane)

BARBITUATES: contraindicated w/ porphyria


Drug Class Mechanism of Action Duration of DOSE
Action Induction
Thiopental (Pentothal) Thiobarbituate GABA mimetic Ultrashort 3-6
(30-60) 4mg/kg
Phenobarbital(Luminal) Oxybarbituate GABA mimetic Long
(24 hours)
Pentobarbital (Nembutal) Oxybarbituate GABA mimetic Short 100mgQ5”
(4-8 hours) max 200-
500mg
Secobarbital (Seconal) Oxybarbituate GABA mimetic Short 4-5mg/kg
(4-8 hours) IM
Methohexital (Brevital) N-Methyl Barbituate GABA mimetic Ultrashort 1-1.5
(30-60min) 3mg/kg
INDUCTION AGENTS:
DRUG Dose MOA DOA Side Effects Other
Propofol 2 mg/kg GABA mimetic 5-10 min Most cardiac Don't use Baxter's
15-45 sec depressive; may formulation for asthmatics/
have antiemetic egg allergy & asthma
effects
Thiopental 3-6mg/kg GABA mimetic 5-10 min depresses
4 mg/kg <30 sec
Etomidate 0.2-0.3 GABA mimetic 3-12 min Good for cardiac/ Blocks 11 beta hydroxylase
mg/kg 15-45 sec sick pts, not for decreasing steroid
porphyria; Causes levels/stress response
myoclonia
Ketamine 1-2mg/kg NMDA receptor 3-12 min Good for Phencyclidine derivative,
(1) antagonism 15- asthmatics, dissociative anesthesia,
45 sec bronchodilator, increases everything:B/P,
HR, IOP, ICP

BENZODIAZEPINES: Flumazenil(Mazicon)- Benzo reversal


DRUG Dose MOA/DOA :GABA Mimetic Other
Midazolam (Versed) 0.5-5mg (2-3mg) Onset: 30sec-1min We use it like water at
DOA: 15-80min ? Beaumont:)
Lorazepam (Ativan) 1-4mg Onset:1-5 min; DOA:6-10 hours
Diazepam (Valium) 2-10mg 5-15mg/kg Onset:<2 min Causes PAIN on
induction DOA:15-1 hour injection
give slow

Droperidol: Dopamine antagonist, good antiemetic, but produces extrapyramidal effects-- don't use
with Parkinson's patients- Parkinsonian-like effects. Black box warning based on QT prolongation
Reglan: also Dopamine antagonist, causes EPS effects
OPIOIDS
DRUG Derivative Dose Onset/ Other
DOA
Morphine Phenanthrene 10mg/ Onset: - Not very potent
Does release 15mg/kg 15-30” - reversed w/ Naloxone, Naltrexone, & Nalmefene
histamines 3-5hr -metabolized in the liver
Meperidine Phenylpiperidine 100mg IM DOA: 2- - Least potent
(Demerol) (don't produce 4hr - Don't give to elderly/renal pts due to toxic metabolite,
histamine release) excreted in urine
- Contraindicated in pts taking MAOI's
- Causes least amt. of biliary spasms
- Causes tachycardia

Fentanyl Phenylpiperidine 100mcg/ 50- 1-1.5 hr - 700mcg/70kg pt = 14 mL


(Sublimaze) don't produce 150mcg/kg - Frontload: give 5min prior to induction
histamine release
Sufentanil Phenylpiperidine 10-20 mcg 0.8- - Most Potent
(Sufenta) don't produce 5-20- 1.3hr - low volume distribution in the body, highly protein
histamine release anesthesia bound
- better for longer cases-- ortho/ open heart
Alfentanil Phenylpiperidine 500- 25- - Lowest vol. Distribution in the body- highly protein
(Alfenta) don't produce 1000mcg/ 40min bound
histamine release 100- - better for outpt/ office procedures
200mcg/kg
Remifentanyl Phenylpiperidine 0.05- 2-5 min - Metabolized in the plasma, instant on/off drug
(Ultiva) don't produce 2mcg/kg/” - Usually run on infusion pump
histamine release - good for long back cases/ neuro cases

OPIOID ANTAGONISTS:
DRUG Dosing/ Other
Naloxone (Narcan) 0.4mg(diluted w/ 3 mL NS-John said usually all
you need), but 1-4 mcg/kg IV (Stoelting)
Naltrexone (Trexane) For ETOH w/drawal, PO, decreases appetite, can
last up to 24 hours
Nalmafene (Revex) 15- 25 mcg IV Narcan derivative, but lasts longer-
10-12 hours