General Anesthetics

MOA Thiopental - Binds GABAA receptor which results in prolonged opening of Clchannel hyperpolarized membrane causing reduction in neuronal excitability - Benzos bind GABA receptor, results in reduced neuronal excitability - Also used to control seizures and in the alcohol withdraw process to control symptoms USE - used for the induction of anesthesia in combo with inhaled anesthetics ADV - no analgesic activity TOX

Midazolam

- used for pre-op sedation, intra-op sedation for procedures not requiring analgesia, and part of balanced anesthesia

** produces ante grade amnesia, which calms the patient -Alone moderate circulatory and respiratory depression -With Opioids cardiovascular collapse and respiratory arrest can occur -Hypotension - Negative inotropic effects -Pain at the site of injection -Apnea ** Metabolized 10X faster than thiopental - Emergence phenomenon consisting of disorientation, sensory and perceptual illusions, and vivid, often Contra: Head Trauma; b/c ketamine raises intracranial pressure, cerebral flow, and oxygen

Propofol

- ultra-fast acting drug similar to thiopental - also used in critical care setting as continuous infusion to provide prolonged sedation - Produces dissociative anesthesia characterized by catatonia, amnesia, and analgesia without

- Induction of anesthesia

Ketamine

actual loss of consciousness

unpleasant dreams ** Diazepam 5 -10 min before helps -Used in general anesthetics in pts. undergoing cardiac surgery or other major surgeries for which cardiac reserve is limited -Excellent analgesic properties

consumption

Morphine Opioid Analgesic Fentanyl Opioid Analgesic Sufentanil Opioid Analgesic Alfentanil Opioid Analgesic Remifentanil Opioid Analgesic Etomidate Misc. SedativeHypnotic

-Opioid receptors in CNS -Opioid receptors in CNS -more potency and less respiratory impact than morphine -Similar to Fentanyl but more potent -Similar to Fentanyl but less potent and shorter acting -Similar to Fentanyl but less potent and shorter acting

- To induce anesthesia hypnotic agent but lacks analgesic activity -used for patients with coronary artery disease or cardiovascular dysfunction such as shock -Selective Alpha2 adenoreceptor agonist that has sedative and analgesic effects -Used in intensive care units for sedation of intubated and mechanically ventilated pts. -For continuous sedation up

-Decreased plasma cortisol and aldosterone levels so prolonged use is not advised

Dexmedetomidine Misc. SedativeHypnotic

-Hypoxia -Bradycardia, Sinus arrest, hypotension, transient hypertension -Nausea, vomiting

Use Caution: -Hepatic impairment -Advanced Heart block -Geriatric pts.

to 24hrs Halothane Volatile Liquid -20% eliminated by metabolism, rest is expired in the air -Still used in the pediatric population due to pleasant odor and lack of hepatotoxicity

-Anemia -Fever -Sensitizes myocardium to the effects of catecholamines - CO, HR therefore BP and peripheral resistance - Some previously exposed pts. can develop life threatening hepatitis halothane hepatitis -fulminant hepatitis cardiac arrhythmias, hypotension -Malignant hyperthermia esp. with succinylcholine -Fluoride ion from metabolism can be nephrotoxic -can decrease the kidney concentrating ability after prolonged exposure

Enflurane Volatile Liquid -2% metabolized in liver to release fluoride ion, rest is expired in air

-Rapid induction and maintenance of general anesthesia

- Less sensitization to catecholamines than halothane

Sevoflurane Volatile Liquid -Small percentage metabolized to fluoride ion, rest is expired in air Isoflurane Volatile Liquid -Almost all expired in air

-Widely used in out-patient surgery -Maintenance of general anesthesia in children b/c non-irritating to the airway -Most commonly used inhaled anesthetic -Maintenance of general anesthesia

-Same as above-coronary vasodilatation

-Doesnt effect CO -Can lower BP and reduce peripheral vascular resistance profoundly -Doesnt sensitize

-Potential for malignant hyperthermia -respiratory depression -airway irritant

myocardium to catecholamines -Doesnt induce arrhythmias Desflurane Volatile Liquid -Eliminated unchanged in expired air Nitrous Oxide Inhaled Gas -Eliminated through lungs -Widely used in outpatient surgery because of rapid onset and recovery -Induction of general anesthesia used in outpatient dentistry in combo with oxygen to provide sedation and significant analgesia -Same as above-

-Minimal cardiovascular effects -can displace oxygen to cause diffusion hypoxia in the alveoli

-Monitor for hypoxia from suppressed ventilation -Contra: -Pneumothorax