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 AgentsNameMechanism of Action Key Indication Key ToxicityGeneral AnestheticsHalothaneCortical, myocardial, respiratory depressionInhaled anestheticHepatotoxicityMalignant hyperthermiaEnfluraneProconvulsantMalignant hyperthermiaMethoxyfluraneNephrotoxicityMalignant hyperthermiaSevofluraneMalignant hyperthermiaNitrous oxideGas expansion when trapped in a body cavityNeuromuscular BlockersDepolarizing AgentsSuccinylcholineAch receptor agonist (sustained depolarization)Depolarizing neuromuscular blockadeHyperkalemiaavoid in burn and crush injury patientsMalignant hyperthermiatreat with dantrolene and coolingNon-Depolarizing Agents (Reversed with Neostigmine and Atropine)PancuroniumCompetitive antagonist of Ach receptorsNondepolarizing neuromuscular blockadeTachycardiaRespiratory depressionAtracuriumVecuroniumRocuroniumSedativesAtropineMuscarinic antagonistSedativeCholinergic crisis (organophosphate poisoning)Dry skinFlushed skinConstipationUrinary retentionCycloplegiaKetamineNMDA antagonistDissociative anestheticNeuropathic pain syndromesDisorientationHallucinationsNystagmus (vertical, horizontal, or rotary)LaryngospasmMidazolamIncreases GABA type A channel opening frequencySedativeRelaxantShort-acting, high potency benzodiazepineRespiratory depressionDecreased blood pressureAmnesiaPropofolPotentiates activity at GABA type A channelsSedationRapid anesthesia inductionPain on injectionDecreased blood pressure (reduces cardiac inotropy)ThiopentalIncreases GABA channel opening durationInduction of anesthesiaRespiratory depressionCardiovascular depressionEtomidateGABAa agonistInduction agentNausea/vomitingSpasmsTransient adrenal suppressionLocal AnestheticsLidocaineBlocks voltage gated sodium channelsLocal anestheticFast onset (minutes)Short duration of symptom control (1-3 hours)SeizuresCardiac toxicitybradycardiaheart blockBupivacaineBlocks voltage gated sodium channelsLocal anestheticSlow onset (15 minutes)Long duration of symptom control (4-8 hours)SeizuresCardiac toxicity