Intravenous Anaesthesia - Etomidate, Ketamine and Daycare Surgery MCQs

Ketamine is a strong analgesic drug and is water soluble. Its injection is not painful. Propofol and etomidate solutions have to be made in oil due to poor water solubility, so these injections are quite painful.(Option B,C) Methohexitone can cause hyperalgesia.(Option D)

A characteristic and desired feature of induction of anaesthesia with Etomidate is cardiovascular stability after bolus injection. In this regard, decrease in systemic blood pressure is modest or absent and principally reflects a decrease in systemic vascular resistance. Therefore, the systemic blood pressure-lowering effects of Etomidate are probably exaggerated in the presence of hypovolemia, and optimization of the patient’s intravascular fluid volume status before induction of anesthesia should be achieved. Reference : LANG’ Basic & clinical pharmacology by Bertram G. Katzung, Susen B. Masters and Anthony J. Trevor 12 th edition. Chapter 25- General Anaesthetics by Dr. Helge Eilers,MD & Dr. Spencer Yost,MD. Page no. 443

Dexmedetomidine markedly increases the range of temperatures not triggering thermoregulatory defences, Thus proving to be an effective treatment for nonthermally induced shivering Severe bradycardia may follow the administration of dexmedetomidine and cardiac arrest has been reported in a patient receiving a dexmedetomidine infusion as a supplement to general anaesthesia Reference: E Book of Morgan and Mikhail's Clinical Anaesthesiology 6th Edition Chapter 17 Page No 496 to 499

Dexmedetomidine is a new generation highly selective α2-adrenergic receptor (α2-AR) agonist The Alpha 2-adrenergic receptor agonists effects - Sedative ( Option C ) Anxiolytic Hypnotic (Option B) Analgesic (Option D) Perioperative sympatholytic effects ( Option A is False) Cardiovascular stabiliser Reduced delirium and agitation Preservation of respiratory functions Reference : E Book of Morgan and Mikhail's Clinical Anaesthesiology 6th Edition Chapter 17 Page No 496 to 499

Ans. is 'd' i.e., Alfentanil Drugs useful for day care surgery o Propofol o Sevoflurane, desflurane & isoflurane o Midazolam o Mivacurium o Alfantanil

Propofol is an intravenous induction agent that can be addictive because of its hypnotic property and development of tolerance on prolonged use The abuse potential is common among health care workers with reports of self-administration Note : Ketamine also has the potential for abuse and addiction. Trivia : The death of music icon, Michael Jackson has been attributed to Propofol intoxication, administered by his personal physician. Though this powerful drug is one of the greatest boons to the field of anaesthesia, administering it without adequate justification, expertise and equipment (to manage airway) can lead to casualties Reference: E Book of Morgan and Mikhail's Clinical Anaesthesiology 6th Edition Chapter 9 Page No 321 to 324

Due to its intense analgesic activity, ketamine has been used extensively for burn dressing changes, debridement’s, and skin grafting procedures. The excellent analgesia and ability to maintain spontaneous ventilation in an airway that might otherwise be altered by burn scar contractures are important advantages of ketamine in these patients. Reference: Stoelting’s pharmacology and physiology in anaesthetic practice 5th edition pg 189

Etomidate: IV anaesthetic agent, introduced in 1973. A carboxylated imidazole (five-membered ring containing three carbon atoms and two nitrogen atoms) compound presented in 35% propylene glycol; pH is 8.1. 75% bound to plasma proteins after injection. Midazolam hydrochloride. Benzodiazepine, used for sedation, premedication and induction of anaesthesia. Has also been used for status epilepticus. Water-soluble at pH Reference: FRCA A TO Z, page no 218 and 380