S3E1 - Induction Agents

Key principles of pharmacology :Pharmacokinetics : What the body does to the drug.A.  AbsorptionD. DistributionM. MetabolismE. ExcretionPharmacodynamics: A drug’s biochemical and physiologic effects on the body.  Receptor binding Receptor sensitivity Post-receptor effects 4 induction agents to familiarize yourself with for the first day in the OR:1. PropofolInhibitory neurotransmission via the GABA receptor Provides reliable amnesia and anesthesia, but does not have any analgesic propertiesPotent cardiac and respiratory depressantEasily titratable due to high volume of distribution and short initial distribution half-lifeInduction dose is 1-2.5 mg/kg2. KetamineNMDA receptor antagonistHas analgesic, amnesia and anesthetic properties.Can cause emergence deliriumCauses central sympathetic stimulation Induction dose 0.5-2 mg/kg 3. MidazolamEnhances the affinity of GABA for its receptorMinimal cardiorespiratory depression and produces anxiolysis and anterograde amnesiaLonger-acting; elimination half-life of 1-4 hoursInduction doses: 0.02- 0.04 mg/kg (1-2 mg in adults)Antagonist available: Flumazenil4. EtomidateIncreases the receptor’s affinity for GABACardio-respiratory stableVery fast onset/offset due to high lipophilicity;  an induction dose of 0.1 mg/kg will provide 1.5 minutes of unconsciousnessProduces a light plane of anesthesia for laryngoscopyCan cause adrenocortical insufficiencySupport the show

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