Updated: 1/2/2021

Anesthesiology Medications

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Anethesiology Drug Introduction
  • Anesthesiology medications can be broken down into the following categories
    • inhaled agents
    • neuromuscular blockers
    • sedatives
    • local agents (adding epinephrine can prolong duration of anesthesia)
Anethesiology Drug Table
 
Inhaled Agents
Name Mechanism of Action  Key Indication  Key Toxicity
General Anesthetics
Halothane
  • Cortical, myocardial, respiratory depression
  • Inhaled anesthetic
  • Hepatotoxicity
  • Malignant hyperthermia 
Enflurane
  • Proconvulsant
  • Malignant hyperthermia
Methoxyflurane
  • Nephrotoxicity
  • Malignant hyperthermia
Sevoflurane
  • Malignant hyperthermia
Nitrous oxide
  • Gas expansion when trapped in a body cavity
Neuromuscular Blockers
Depolarizing Agents
Succinylcholine
  • Ach receptor agonist (sustained depolarization) 
  • Depolarizing neuromuscular blockade
  • Hyperkalemia
    • avoid in burn and crush injury patients 
  • Malignant hyperthermia
    • treat with dantrolene and cooling 
Non-Depolarizing Agents (Reversed with Neostigmine and Atropine)
Pancuronium
  • Competitive antagonist of Ach receptors 
  • Nondepolarizing neuromuscular blockade
  • Tachycardia
  • Respiratory depression
Atracurium
Vecuronium
Rocuronium
Sedatives
Atropine
  • Muscarinic antagonist
  • Sedative
  • Cholinergic crisis (organophosphate poisoning)
  • Dry skin
  • Flushed skin
  • Constipation
  • Urinary retention
  • Cycloplegia 
Ketamine
  • NMDA antagonist 
  • Dissociative anesthetic
  • Neuropathic pain syndromes 
  • Disorientation
  • Hallucinations 
  • Nystagmus (vertical, horizontal, or rotary)
  • Laryngospasm 
Midazolam
  • Increases GABA type A channel opening frequency
  • Sedative
  • Relaxant
  • Short-acting, high potency benzodiazepine
  • Respiratory depression
  • Decreased blood pressure
  • Amnesia 
Propofol
  • Potentiates activity at GABA type A channels 
  • Sedation
  • Rapid anesthesia induction
  • Pain on injection
  • Decreased blood pressure (reduces cardiac inotropy) 
Thiopental
  • Increases GABA channel opening duration
  • Induction of anesthesia
  • Respiratory depression
  • Cardiovascular depression
Etomidate
  • GABAa agonist 
  • Induction agent
  • Nausea/vomiting
  • Spasms 
  • Transient adrenal suppression 
Local Anesthetics
Lidocaine
  • Blocks voltage gated sodium channels 
  • Local anesthetic
    • Fast onset (minutes)
    • Short duration of symptom control (1-3 hours)
  • Seizures
  • Cardiac toxicity
    • bradycardia
    • heart block
Bupivacaine
  • Blocks voltage gated sodium channels
  • Local anesthetic
    • Slow onset (15 minutes)
    • Long duration of symptom control (4-8 hours)
  • Seizures
  • Cardiac toxicity

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(M2.PH.14.39) A 4-year-old boy is brought to the emergency department by his mother after cutting his buttock on a piece of broken glass. There is a 5-cm curvilinear laceration over the patient's right buttock. His vital signs are unremarkable. The decision to repair the laceration is made. Which of the following will offer the longest anesthesia for the laceration repair?

QID: 106250
1

Bupivacaine

20%

(2/10)

2

Bupivacaine with epinephrine

70%

(7/10)

3

Lidocaine

10%

(1/10)

4

Lidocaine mixed with bupivacaine

0%

(0/10)

5

Lidocaine with epinephrine

0%

(0/10)

M 7 E

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