Lecture 6 - Injectable Anesthetics II

Ketamine

Which dissociative anesthetic is a racemic mixture, is closely related to PCP, is a schedule III drug, can be given IV, IM, SC, IP, transmucosal, or epidural, is an NMDA antagonist, while also a weak opioid agonist, anticholinergic, adrenergic, weak GABA A agonist, and Na channel blocker in high concentrations? It is lipid soluble, protein binding, has rapid distribution, 30-90 second onset after IV, 30-45 minute duration, and can accumulate so it should be disconnected before waking the patient up.

NMDA

Antagonism of which receptor is the main effect of ketamine? It works on the brain and spinal cord, is non-competitive, and blocks the channels.

30-60

What time range in seconds should an anesthetist wait after inducing anesthesia with propofol and ketamine?

No

Do dissociative anesthetics cause CNS depression?

Yes

Do dissociative anesthetics maintain reflexes?

Yes

Can ketamine be given in TIVA?

No

Should ketamine be used in patients with hypertrophic cardiomyopathy, hepatic insufficiency, increased ICP, increased IOP, or critically ill patients?

Stimulation

Will ketamine cause sympathetic system stimulation or depression (HR, MAP, CO, Oxygen consumption)?

Apneustic

What breathing pattern can be seen in patients while under the influence of ketamine? This is when there are severe prolonged gasping inhalations, and due to this the airway should be secured so that the patient can still breath as comfortably as possible.

Yes

Is ketamine analgesic, placenta-crossing, and synergistic with analgesics?

Tiletamine

Which dissociative anesthetic, when added with zolazepam, has a longer duration than ketamine and is more potent than ketamine? It has an onset of 60-90 seconds, is painful if given IM, and is associated with rough recoveries. It is used for induction of anesthesia, for transport, for surgical anesthesia only in cats, and for shelter medicine.

Zolazepam

Which benzodiazepine is added to tiletamine but cannot remove its side-effects like muscle rigidity? Addition of alpha-2 agonists or opioids are used to do this.

No

Should tiletamine be used in rabbits, in patients with head trauma, intracranial tumors, intraocular globe procedures, or hypertrophic cardiomyopathy?

Ketamine

Which induction agent has the least respiratory depression, increases CO, does not do vasodilation, increases ICP, and causes muscle rigidity?

Etomidate

Which induction agent has the normal effects except that it does not affect CO?

Thiopental

Which induction agent has the normal effects while also causing arrythmias?

Propofol

Which induction agent causes the strongest respiratory depression?

TIVA

What technique refers to using only IV anesthetic agents, uses an anesthetic and an analgesic, is given through constant infusion or boluses, causes less pollution, and is used for airway procedures, bronchoscopy, and field procedures?

PIVA

Which technique refers to using inhalational anesthetic agents and injectable anesthetics? This helps reduce negative effects of inhalation agents.