What does succinylcholine cause?
Initial *muscle fasciculations followed by paralysis
- it binds to the motor end plate
- “activates” or “stimulates the muscle to initially cause a muscle contraction
- followed by paralysis of that muscle
(Anesthesia-Paralytics)
What type of neuromuscular blocker is succinylcholine?
Depolarizing
Anesthesia-Paralytics
Which is the only neuromuscular blocker that can be given by IM injection?
Succinylcholine
Anesthesia-Paralytics
Describe succinylcholine muscular fasciculations.
Upon administration, the body:
- starts to demonstrate rapid small *muscle contractions
- stop within 30 seconds
(Anesthesia-Paralytics)
Describe the half life and duration of pancuronium (Pavulon).
Half life: 110 minutes
Duration: up to 100 minutes
(Anesthesia-Paralytics)
What is another name for neuromuscular blockers?
Paralytics
Anesthesia-Paralytics
Describe the onset of action and duration of action of succinylcholine.
*Short
Onset: less than 1 minute
Duration: 4-6 minutes
(Anesthesia-Paralytics)
What should be given to a patient before giving a neuromuscular blocker and why?
*Sedative hypnotic
- patient can hear, see, and experience everything going on around them (if awake)
- also cannot breathe on their own
- can be a terrifying experience
(Anesthesia-Paralytics)
Which electrolyte disorder can succinylcholine cause?
- Hyperkalemia
- potassium can be released from inside the cell and into the blood
- thereby raises the blood levels of potassium
- occurs during the phase of fasciculations
- could increase the risk of *cardiac dysrhythmias if the patient already has a baseline elevation in potassium
(Anesthesia-Paralytics)
What are general contraindications or concerns about the use of succinylcholine?
- *hyperkalemia
- *rhabdomyolysis
- significant *3rd degree burns
- high *intracranial pressures (ICPs)
- high *intraocular pressures affecting vision
(Anesthesia-Paralytics)
What type of procedures is succinylcholine ideal for?
- Short procedures; not long surgeries
- short onset of action
- shortest duration of action
(Anesthesia-Paralytics)
What is the MOA of ketamine (Ketalar)?
Non-competitive *NMDA receptor antagonist
- causes a *dissociative anesthesia
- also provides *analgesia
(Anesthesia-Anesthesia)
In what patient populations does ketamine show a potential advantage in?
- Asthmatics or those with *reactive airway disease
- has *bronchodilatory effects
- does not impair respiratory drive
Patients needing *blood pressure support or maintenance of *hemodynamic support
-has positive inotropic effects
(Anesthesia-Anesthesia)
What is the MOA of etomidate (Amidate)?
Non-barbiturate sedative / hypnotic
Anesthesia-Anesthesia
What is the effect of etomidate on the heart at normal doses?
Neutral on its effects
Anesthesia-Anesthesia
What is the MOA of lorazepam (Ativan) and midazolam (Versed)?
*Benzodiazepine
-augments the activity of *GABA
—causes hyperpolarization of the neurons
Associated with amnesia
(Anesthesia-Anesthesia)
What is the MOA of propofol (Diprivan)?
- General anesthetic
- potentiates the activity of *GABA
(Anesthesia-Anesthesia)
What is the effect of propofol on the heart?
Associated with a reduction in *inotropy
Anesthesia-Anesthesia
In what patient population may ketamine’s increase in cardiac output or blood pressure theoretically be a harmful effect?
Patients with:
-increased *intracranial pressure from *traumatic brain injury
(Anesthesia-Anesthesia)
What effect does etomidate have on the adrenal glands?
Has been shown to impart *cortisol production in the adrenal glands
-potentially increases the risk of *adrenal insufficiency
(Anesthesia-Anesthesia)
What is the MOA of dexmedetomidine (Precedex)?
Highly selective centrally acting *alpha-2 agonist sedative / hypnotic
- does not normally suppress the *respiratory drive
- known to lower *blood pressure
(Anesthesia-Anesthesia)
By what routes can ketamine be given?
IM or IV
Anesthesia-Anesthesia
What patients are at risk when receiving propofol, and which side effect would these patients be at a higher risk to experience?
*Hypotension
Patients with:
-known *heart failure
—especially *systolic HF that is associated with poor cardiac output
-hypovolemia
—IV fluids should be available before or during use (assuming the patient can tolerate the extra fluid)
(Anesthesia-Anesthesia)
What kind of dosage form is propofol available as?
- Lipid based emulsion for IV injection
- may need to have *triglycerides checked on a prolonged infusion
(Anesthesia-Anesthesia)
