IV INDUCTION

AGENTS
1) SODIUM THIOPENTONE
2.5% solution/Only Barbiturate/
GABA-R agonist
2) PROPOFOL
1% in intralipid
GABA-R agonist
3) KETAMINE
1%/5%/10%
NMA-R antagonist
4) ETOMIDATE
0.2%
GABA-R agonist
GENERAL
Re!e!ber ar!-brain
"ir"ulation ti!e # $ree
$ra"tion %albu!in et"&
'ello( po(der ) (ater. Garli"
s!ell. p* 10.5 %e+tre!ely
al,aline&
-+tre!ely rapid onset. Bound to
albu!in.
-+tre!ely $at soluble
.ntralipid "ontents
Gly"erol burns on in/e"tion
0 dose elderly
1o!plete anaest2eti"
32en"y"lidine deri4ati4e.
NMA-R
3re"ursor to 56 %spe"ial
7888&
6eldo! used
-+pensi4e
1arbo+ylated i!ida9ole
deri4ati4e
SIDE EFFECTS
Al,aline ne"rosis i$ in/e"ted into
tissue. .s"2ae!ia i$ in/e"ted into
artery not 4ein
R: 5igno"aine; papa4erine;
2eparin saline; ple+us blo",
Burn on in/e"tion
Myo"loni" !o4e!ents
.ntra-op a(areness %"ardia"
and 1/6&
B<= good be"ause
antie!eti"; an+iolyti";
a!nesia; antipruriti"; no
2ango4er and >.AGRA .N A
>.A5888
.n"reased se"retions/!us"le
tone (it2 !o4e!ents
rea!s/2allu"inations/deliriu
!
Burns on in/e"tion
%BRAND)
Myo"loni"
!o4e!ents(BEWE)
6e4ere 3ON> %BRAAK)
Bad adrenal ???&-
addisonian "risis i$ =.>A
%BADRENAL)
BAIE DUUR!
CNS
*ypnoti"
Good anti"on4ulsant
Bene$i"ial i$ neurologi"ally
"o!pro!ised %?.13&
*ypnoti"; good
sedati4e/a!nesti"
?.13/ 1MR02
-roti" drea!s
Good anti"on4ulsant
Raises .13
Not $or "on4ulsions
3etite !al a"ti4ity noted
@ .13/ 1MR02
?.13/ 1MR02
--G asso"iated (it2 grand
!al epilepsy.
*ig2 in"iden"e !yo"loni"
!o4e!ents
CVS
? 1O. =a"2y "o!pensates $or
10% drop in B3.
>asodilation and ? !yo"ardial
"ontra"tility
3roble! - ?B3 by A0%
>asodilation; ? 1O; NO
"o!pensatory ta"2y
1are$ul (it2 t2is888
6ti!ulates 1>6. 1an @ B3;
good $or s2o",ed patient.
*=/ta"2y"ardia/@1O
CVS STABLE!!!
>-R' 6MA55 ? in B3
6upply/de!and ,ept
RESPIRATORY
@upper air(ay
re$le+es%sensitises&
%laryngospas!/bron"2ospas!&
Apnoea $or 2 !inutes
*i""oug2s/"oug2
?upper air(ay re$le+es
Apnoea B0 se"onds; (orse i$
in/e"t $ast
No air(ay suppression
Good bron"2odilator
Nor!al response ? 1O2
Re$le+es !aintained
*yper4entilation %apnoea&
1oug2ing/2i""oug2ing
?dri4e to ? 1O2
6a$e in ast2!ati"s
INDICATIONS
1on4ulsions %3-=/epilepsy&
Brain .n/ury eg 6tro,e/1>.
%?1MR02&; $o"al in/ury
Only really used $or GA in
pregnant (o!en
1on4ulsions %%?1MR02&
3er$e"t $or 5MA
Good $or =.>A/"ons"ious
sedation
6a$e porp2yria/ !alignant
2ypert2er!ia/,idney disease
Good $or analgesia/burns
=.>A.
6ole agent s2ort pro"edures
3oor ris, surgery eg
=a!ponade
-!ergen"ies/di$$i"ult air(ay
1>6 6=AB5-
CONTRAINDICATION
S
Fi!" C#$"i#% O&'(&')*+,%-
i$$i"ult Air(ay
Adrenal insu$$i"ien"y
1are$ul in atopi" patients
3orp2yria
6oya beans/egg allergy Not $or @ .13/.O3; *=;
aneurys!; psy"2 patient;
epilepti"; open eye in/ury.
A4oid in neurosurgery
A4oid in "riti"ally ill.
1are$ul li4er disease %@CC&
eg (it2 "irr2osis
--G asso"iated (it2 grand
!al epilepsy.
OTHER
NO .#&*!# #." /,0i'i.1
.ndu"tion A-D!g/,g
Metabolised in li4er; "an indu"e
o(n !etabolis!.
3ropo$ol .n$usion 6yndro!e
R: Epa"e!a,er/dialysis
Good antie!eti"
3re!ed 1.5-2.5!g/,g
<npre!ed 2.25-2.5!g/,g
Metabolis! 5i4er
5i4er to !etabolise; ,idney
to e+"rete
1-2!g/,g .> %nystag!us&
0.25-0.5!g/,g analgesia
Re$le+es !aintained
0.2-0.A!g/,g
Add an opiate $or s!oot2
indu"tion/intubation
3otentiates NMRs
N)> B0-A0%
5i4er !etabolis!