Pharmacology and drug choices.

  1. The most commonly used IV induction agents are propofol, pentothal and etomidate. Which would be appropriate choices for intravenous induction agents in the following case scenarios? Consider some drawbacks and benefits of each choice.
    • Healthy 18 year old scheduled for outpatient inguinal hernia repair.
    • 85 year old with known CAD and hypovolemia for emergency surgery.
    • 50 year old with large intracranial mass and known increased ICP.
  2. A surgeon tells you he just returned home from the Amazon Jungle. He says most anesthetics there were performed using ketamine (and sometimes oxygen) alone by IM injection. He wants to know why ketamine isn't used as the sole anesthetic here as well. What potential problems might occur using ketamine?
  3. In what operating room situations would you choose to use fentanyl vs. morphine vs. meperidine vs. nubain??? What characteristics of these narcotics lead to your choices?
  4. A 45 year old with ESRD, IDDM, right sided weakness from previous CVA and end-stage alcoholic liver disease presents for bowel obstruction surgery ........... what muscle relaxant(s) might you choose to use in this patient? Why? What paralytic agent(s) should you definitely avoid here? Why do we use paralytic agents for intubation? In which surgical cases would continuous muscle relaxation be beneficial?
  5. The surgeon is ready to make incision and the expired Sevoflurane concentration is 1.2%. If no other anesthetics are being used, will the patient move with surgical stimulus or are they adequately anesthetized? How do you know? What effects will Sevoflurane and Isoflurane have on your patient's cardiovascular and respiratory systems?
  6. Are there any special medications you would want to give preoperatively to an extremely anxious patient? What about the patient at very high aspiration risk? What are the risks of premedicating a patient?