INTRAVENOUS ANESTHETICS

CLASS SPECIFIC ANESTHESIA CLINICAL USE SPECIFIC FEATURE GENERAL FEAUTURES

/EFFECTS
 Not given in patients
BARBITURATES with porphyria 
stimulation of
aminolevulinic acid
THIOPENTAL 3-5mg/kg IV ANTICONVULSANT synthase  inc.
Hepatic metabolism by production of
oxidation, N- porphyrin
dealkylation, CNS
desulfuration
 Dose-dependent
THIOAMYLAL depressant
METHOHEXITAL 1-1.5mg/kg IV EPILEPTIC FOCI  No analgesia but
 Shorter t1/2 Hepatic metabolism by HYPERALGESIA
oxidation, N-  “truth serum”
dealkylation,  Neuroprotective (not
desulfuration in global ischemic
Rectal suppository attack)
Respiratory
 Depressant
 Laryngeal reflex
intact (not for
asthmatics)
Cardiovascular
 Negative inotropic
effect
 Peripheral
vasodilation = dec.
BP
  Inc. venous
capacitance w/out
changes in TPR
GIT
 PONV
Renal and Hepatic
 Dec. blood flow but
no change in
function.
Allergic reaction
 Rare but life-
threatening

BENZODIAZEPINES

DIAZEPAM  BEST ANXIOLYTIC,

LORAZEPAM SEDATIVE,
AMNESIC
MIDAZOLAM For laparoscopy
Rectal suppository  For pre-operative
seizures
 Diagnostic
procedures
(laparoscopy)
 For short
procedures
 CNS
 Drowsy (w/in 2-3
mins)
 Anterograde
amnesia
 Anxiolysis
 Dec. black flow
 Poor
neuroprotectant
Respiration
 Negligible
Cardiovascular
 Negligible
GIT
 PONV
Renal and Hepatic
 Negligible

OPIODS
MORPHINE Gold standard Only opioid that causes  Cardiac surgery
SULFATE (Gold stnd) CVS depression due to  Px w/ limited
histamine release (NOT respiratory
FOR CABG) reserve
 No amnesia
Only that causes PONV produced
 FOR POST-
FENTANYL Causes chest wall rigidity OPERATIVE
up to larynx (rapid
 distribution, Tx: NM ANALGESIA AND
blocker) INTRAOPERATIVE
BALANCED
SULFENTANIL ANESTHESIA
REMIFENTANIL Used for minimizing Onset: 7 secs
residual ventilator DOA: 15 mins (reinject Neuroletanalgesia =
depression every before 15 minutes) droperidol + fentanyl
 Cosmetic surgery
 Px can walk and
talk

Neuroleptanesthesia =
droperidol + fentanyl +
N2O

CNS
 Onset: 10-20 secs
 DOA: 30 mins
(needs to be given
every before 30
mins span)

To avoid concentrated
doses, dilute 1cc to 9cc of
water in 10cc syringe

CVS
 Minimal
depression
 Used in coronary
artery bypass
graft (CABG)
GIT
 none
PROPOFOL (2,6-DIISOPROPYLPHENOL)
PROPOFOL MOST POPULAR IV Metabolized in the liver,  AMBULATORY
 alkyl phenol w/ ANESTHESIA FOR and lungs (up to 30%) ANESTHESIA
hypnotic CELEBRITIES  Less hangover
properties that is ANTIEMETIC compared to
chemically GOOD FOR PROCEDURES ANTICONCVULSANT thiopental
distinct from NOT NEEDING NO ANALGESIA  Sedative in ICU
other groups of IV ANALGESIA  Maintenance IV
anesthesia PRONOUNCED MOST BP anesth in operation
 formulated in an DECREASE
emulsion (10% Brief and fast recovery + Onset: 20-40 secs
soybean oil, no hangover DOA: 8-10 mins
2.25% glycerol, (rapid onset and DOA)
1.2% lecithin) bolus injection:
1-2.5 mg/kg IV CNS
 Hypnotic
Maintenance dose:  NO ANALGESIA
3-8 mcg/kg IV  Dec. ICP & IOP
(neuroprotective)
 ANTICONVULSANT
 Bursts suppression
in EEG
RESPIRATORY
 Depressant
 APNEA
 Dec. Vmin
 Decreased response
to hypoxia and
hypercapnia
  NO REFLEX
HYPERVENTILATION
CVS
 Negative inotropic
effect
 MOST
PRONOUNCED BP
DECREASE IN ALL IV
ANESTH (profound
vasodilation)
 No baroreflex
 Bradycardia and
asystole
GIT
 ANTIEMETIC

ETOMIDATE
ETOMIDATE  Alternative to Rapid onset-Rapid  Alternative to
 Carboxylated PROPOFOL and redistribution-short PROPOFOL and
imidazole BARBITURATES duration with a biphasic BARBITURATES
derivative for rapid IV plasma concentration for rapid IV
 Poorly H2O induction curve: induction
soluble in a especially for Px 1st T1/2: 3 mins  For Px w/ dec.
2mg/mL solution with 2nd T1/2: 29 mins CVS reserve
in 35% propylene compromised
glycol myocardial NO ANALGESIA DOA: (linearly related to
contractility NO NEUROPROTECTION dose)
EPILEPTIC FOCI 0.1mg/kg in 100 seconds
0.2-0.3 mg/kg IV of unconsciousness
Metabolism by ester
hydrolysis CNS:
Excreted:  Potent cerebral
 Urine: 78% (<3% vasoconstrictor
excreted as  Dec. cerebeal
unchanged drug blood flow and
in urine) ICP
 Bile: 22%  CAUSES
MYOCLONUS
Clearnce is 5 times faster Respiratory
than thiopental  Apnea
CVS
77% is protein-bound  STABLE
(albumin) in plasma HEMODYNAMIC
EFFECT
INHIBITS 11-B GIT
HYDROXYLASE   PONV
hypocortisolism Endocrine
 INHIBITS 11-B
HYDROXYLASE 
adrenocortical
suppression 
dec.cortisol 
hypocortisolism
KETAMINE
KETAMINE Used for poor risk ANALGESIC  1ST 2mL is painful,
 Racemic mixture patients ANESTHETIC administer with
of two optical INCOMPLETE AMNESIA LIDOCAINE
isomer S(+) (more Patients in shock ANTICONVULSANT
potent) and R(-) CNS
 Highly-lipid Good for young patients SIMILAR TO THE  DISSOCIATIVE
soluble (children) = INDUCES PSYCHEDELIC DRUG ANESTHESIA
DREAMS CALLED PHENCYCLIDINE (cataleptic state)
 “DISSOCIATIVE  Unpleasant
BURN PATIENTS ANESTHESIA” (eyes emergence
remain open with a slow reactions:
Outpatient surgery mydriatic nystagmic gaze: 1. Vivid, colorful
cataleptic state) dreams
Short procedures 2. Hallucinations
Metabolized by N- (hallucinosis)
NOT FOR HYPERTENSIVE demethylation by the 3. Out-of-body
PATIENTS cytochrome P450 system experience
 NORKETAMINE is the 4. Distorted senses
Patients: less potent primary 5. Fear, confusion
 Asthmatics metabolite but euphoric
 Ectopic pregnant
Increased lacrimation and  INCOMPLETE
salivation AMNESIA
 Cerebral
vasodilator
 May cause
MYOCLONUS
 ANTICONVULSANT
(alt. for status
epilepticus)
  SYMPATHETIC
STIMULATION
Respiratory
 Intact reflex
 Bronchodilation
(GOOD FOR
ASTHMATICS)
CVS
 SYMPATHETIC
STIMULATOR
(isipin nyo nalang)
 NOT FOR
HYPERTENSIVE Px
GIT
 Inc. salivation and
lacrimation
 No PONV
 Intact laryngeal
reflex
Musculoskeletal
 Inc. muscle tone

DEXMEDETOMIDINE
DEXMEDETOMIDINE Used for short term Hepatic metabolism via CNS
 -2 agonist sedation of intubated and conjugation, N-  Hypnosis
ventilated Px in ICU methylation, and  Analgesic
hydroxylation then  Sedative
Induction dose: conjugation
0.5 – 1 mcg/kg IV over 10-  Dec. cerebral
15 mins Biphasic clearance blood flow & ICP
CVS
Maintenance dose:  Dec. HR, TPR and
0.2-0.7 mcg/kg BP
Respiratory
 Possible airway
obstruction
 Depressant