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Updated: Sep 18 2020

Intravenous Anesthetics

  • Snapshot
    • A 36-year-old man presents to the hospital for an elective bariatric procedure. The patient followed instructions not to eat for a given amount of hours prior to the surgery. While on the surgical table, the anesthesiologist induces anesthesia with an intravenous bolus of propofol, along with a number of other agents used.
  • Introduction
    • General anesthesia
      • is a central nervous system (CNS) depressive state that is reversible and provides
        • analgesia
        • sedation and decreased anxiety
        • amnesia and impaired consciousness
        • relaxation of skeletal muscle
        • prevention of reflexes
      • can be divided into
        • intravenous anesthesia
        • inhaled anesthesia
    • Intravenous (IV) anesthesia
      • causes a rapid induction of anesthesia
        • when the anesthetic enters the blood, a portion of it binds to plasma proteins (bound) while the rest are unbound
          • the binding ability of the IV anesthetic is dependent on numerous factors, such as
            • drug ionization
            • lipid solubility
        • after entering the venous blood and goes to the heart and into the cerebral circulation
          • the anesthetic enters the brain at a rate that depends on
            • arterial concentration of unbound drug
            • lipid solubility
            • degree of ionization
          • the higher the arterial concentration of the unbound drug, lipid solubility, and nonionized molecules
            • the faster the anesthetic enters the brain
        • eventually, the anesthetic leaves the CNS (redistribution), resulting in
          • recovery from the IV anesthetic
  • Intravenous Anesthetic
      • Intravenous Anesthetic
      • Drugs
      • Clinical Use
      • Comments
      • Thiopental
      • Induction of anesthesia
      • Short surgical procedures
      • A short acting barbiturate that
        • has a high lipid solubility
        • is a potent anesthetic
        • is a weak analgesic
        • has a rapid redistribution; thus,
          • it rapidly diffuses out of the brain
      • May cause
        • apnea
        • laryngospasm
        • bronchospasm
      • Midazolam
      • Induction of anesthesia
      • Endoscopy
      • Can result in
        • temporary forms of anterograde amnesia
        • post-operative respiratory depression
      • Treat overdose with
        • flumazenil
      • Opioids
      • To induce analgesia
      • Fentanyl is commonly used
      • Can result in
        • hypotension
        • respiratory depression
        • muscle rigidity
      • Etomidate
      • Induction of anesthesia
      • Can reduce
        • adrenal steroid production
          • which can result in
            • acute adrenal crisis
      • Ketamine
      • Induction of a dissociative anesthetic state
      • Ketamine
        • is a NMDA receptor antagonist
        • increases central sympathetic outflow, which in turn increases
          • blood pressure
          • cardiac output
          • bronchodilation
        • increases cerebral blood flow
        • may result in hallucinations
        • prevents opioid-induced acute tolerance
      • Propofol
      • Induction and/or maintenance of anesthesia
      • Decreases blood pressure
      • Reduced intracranial pressure
      • Low incidence of post-operative nausea and vomiting
      • Potentiates GABAA
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