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Propofol

Authors: Ryden Armstrong Reviewers: Billy Sun Joseph Tropiano Melinda Davis, MD Propofol Abbreviations GABA – Ga mma-a minobutyric acid Quick Facts 1° Indication = Induction and maintenance of general anesthesia, sedation Route of Administration = IV Metabolism & Excretion = Redistribution, hepatic conjugation/ renal clearance Legend: Pathophysiology Mechanism Allosterically increases binding affinity of inhibitory neurotransmitter GABA for GABAA receptor i Prolonged opening of chloride channel 1 Hyperpolarization of nerve membrane Inhibitory effect on CNS I Induction/maintenance of general anesthesia Sign/Symptom/Lab Finding Injection site pain Can pre-treat with intravenous local anesthetic (lidocaine) 4, Cerebral metabolic rate CNS —÷ 4, Cerebral oxygen consumption 4, Intra-cranial pressure 4, Systemic vascular resistance Hypotension ► Cardiovascular --■ —■ (with no change 4, Preload in heart rate) 4, Contractility Respiratory / ♦ Hypercapnia 4, Hypoxic and --■ hypercapnic Hypoxia respiratory drive ♦ Apnea 4, Upper airway reflexes Complications I Published MARCH 3, 2018 on www.thecalgaryguide.com Lac.).T2

Rapid Sequence Induction and Intubation (RSII): Clinical Approach

Rapid Sequence Induction and Intubation (RSII): Clinical Approach Authors: Sandy Ly Reviewers: Wendy Yao Melinda Davis* * MD at time of publication Reversible with Sugammadex (selective relaxant binding agent) Responds to acetylcholinesterase Reversible with acetylcholinesterase inhibitors Not immediately reversible due to high dose Classical RSII Modified RSII Induction Agent e.g. Ketamine or Propofol (2 mg/kg) Inhibitory effect on central nervous system Cricoid pressure (10 lbs pressure posteriorly) Esophagus at the level of the cricoid obstructed Reduced gastric regurgitation Succinylcholine (2 mg/kg) acts similar to Ach Depolarize end plate nicotinic receptors in skeletal muscle Non-competitive with no antagonist Rapid skeletal muscle paralysis (<30 seconds) with short duration (<10 minutes) Irreversible Preoxygenation with 100% O2 displaces nitrogen. Functional residual capacity (2.5L) is filled with O2 Oxygen consumption (250 mL/min) Extend time to desaturation (Ideal condition: 10 minutes) Gastric distension with use of bag valve mask ventilation (positive pressure) High dose Rocuronium (1 mg/kg) competitively antagonizes Ach Decreased Ach binding on nicotinic receptors in skeletal muscle Rapid skeletal muscle paralysis (<60 seconds) with long duration (>45 minutes) Quick Facts Induction of anesthesia Abbreviations Ach – acetylcholine See other pathways for more detailed pathophysiology • • • RSII is used in patients with increased risk of gastric aspiration. Cricoid pressure is NOT THE SAME as BURP (backward, upward, rightward pressure). Other induction agents possible (e.g. etomidate). Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published September 22, 2019 on www.thecalgaryguide.com

Propofol français

Propofol français