RT Book, Section
A1 Butterworth IV, John F.
A1 Mackey, David C.
A1 Wasnick, John D.
SR Print(0)
ID 1161426512
T1 Intravenous Anesthetics
T2 Morgan & Mikhail's Clinical Anesthesiology, 6e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259834424
LK accessmedicine.mhmedical.com/content.aspx?aid=1161426512
RD 2022/05/20
AB KEY  CONCEPTS  Repetitive  administration  of  highly  lipid-soluble  barbiturates  (eg,  infusion  of  thiopental  for  “barbiturate  coma”  and  brain  protection)  saturates  the  peripheral  compartments,  minimizing  any  effect  of  redistribution  and  rendering  the  duration  of  action  more  dependent  on  elimination.  This  is  an  example  of  context  sensitivity.  Barbiturates  constrict  the  cerebral  vasculature,  causing  a  decrease  in  cerebral  blood  flow,  cerebral  blood  volume,  and  intracranial  pressure.  Although  apnea  may  be  relatively  uncommon  after  benzodiazepine  induction,  even  small  intravenous  doses  of  these  agents  have  resulted  in  respiratory  arrest.  In  contrast  to  other  anesthetic  agents,  ketamine  increases  arterial  blood  pressure,  heart  rate,  and  cardiac  output,  particularly  after  rapid  bolus  injections.  Induction  doses  of  etomidate  transiently  inhibit  enzymes  involved  in  cortisol  and  aldosterone  synthesis.  When  used  for  sedation  in  the  intensive  care  unit,  etomidate  was  reported  to  produce  consistent  adrenocortical  suppression.  Propofol  formulations  can  support  the  growth  of  bacteria,  so  sterile  technique  must  be  observed  in  preparation  and  handling.  Propofol  should  be  administered  within  6  h  of  opening  the  ampule.