Induction Agents, Opiates and Anxiolytics
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Propofol |
Metabolism and excretion |
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Effect on circulation |
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Effect on respiration |
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Effect on other organs |
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Drug interactions |
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Adverse effects |
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References:
- Favetta P, Degoute C-S Perdrix J-P, Dufresne C, Boulieu R, Guitton J (2002). “Propofol metabolites in man following propofol induction and maintenance”. British Journal of Anaesthesia 88: 653–8.
- Veselis RA, Reinsel RA, Feshchenko VA, Wroński M (October 1997). “The comparative amnestic effects of midazolam, propofol, thiopental, and fentanyl at equisedative concentrations”. Anesthesiology 87 (4): 749–64.
- Deutschman Clifford S, Harris Andrew P, Fleisher Lee A. Changes in heart rate variability under propofol anesthesia: a possible explanation for propofol induced bradycardia. Anesthesia & Analgesia. August 1994;79(2).
- H Stephan, H Sonntag, HD Schenk, D Kettler, HJ Khambatta. Effects of propofol on cardiovascular dynamics, myocardial blood flow and myocardial metabolism in patients with coronary artery disease. Br J Anaesth 1986;58(9):969-975.
- Duvaldestin P. Respiratory effects of propofol. Ann Fr Anesth Reanim. 1987;6(4):226-7.
- A Peratoner, CS Nascimento, MCE Santana, RA Cadete, EM Negri, A Gullo, PRM Rocco, WA Zin. Effects of propofol on respiratory mechanic and lung histology in normal rats. Br J Anaesth 2004;92(5):737-740.
- Wu RS, Wu KC, Sum DC, Bishop MJ. Comparative effects of thiopentone and propofol on respiratory resistance after tracheal intubation.
- Bandschapp O, Filitz J, Ihmsen H, Berset A, Urwyler A, Koppert W, Ruppen W. Analgesic and antihyperalgesic properties of propofol in a human pain model. Anesthesiology 2010 Aug;113(2):421-8.
- Schricker T, Klubien K, Carli F. The independent effect of propofol anesthesia on whole body protein metabolism in humans. Anesthesiology 1999 Jun;90(6):1636-42.
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Etomidate |
Metabolism and excretion |
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Effect on circulation |
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Effect on respiration |
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Effect on other organs |
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Drug interactions |
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Adverse effects |
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References:
- Dolin, S. J. “Drugs and pharmacology” in Total Intravenous Anesthesia, pp. 13-35 (Nicholas L. Padfield, ed), Butterworth Heinemann, Oxford, 2000
- Stoelting, R. K. and Miller, R.D. Intravenous Anesthetics, in Basics of Anesthesia, 4th edition, pp. 58-69, Churchill-Livingstone, 2000.
- Cotten JF, Hussain SS, Forman SA< Miller KW, Kelly EW, Nquyen HH, Raines DE. Methoxycarbonyl-etomidate: a novel rapidly metabolized and ultra short acting etomidate analogue that does not produce prolonged adrenocortical suppression. Anesthesiology 2009 Aug;111(2):240-9.
- Atiba JO, Horai Y, White PF, Trevor AJ, Blaschke TF, Sung ML. Effect of etomidate on hepatic drug metabolism in humans. Anesthesiology 1988 Jun;68(6):920-4.
- Sprung J, Ogletree-Hughes ML, Moravec CS. The effects of etomidate on the contractility of failing and nonfailing human heart muscle. Anesth Analg 2000 Jul;91(1):68-75.
- Lindeburg T, Spotoft H, Bredgaard Sarensen M, Skovsted P. Cardiovascular effects of etomidate used for induction with fentanyl-pancuronium for maintenance of anaesthesia in patients with valvular heart disease. Acta Anaesthesiol Scand 1982 Jun;26(3):205-8.
- Morgan M, Lumley J, Whitwam JG. Respiratory effects of etomidate. Br J Anaesth 1977 Mar;49(3):233-6.
- Janice K Yeung, Peter J Zed. A review of etomidate for rapid sequence intubation in the emergency department. CJEM 2002 May;4(3).
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ketamine |
Metabolism and excretion |
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Effect on circulation |
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Effect on respiration |
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Effect on other organs |
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Drug interactions |
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Adverse effects |
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References:
- Kharasch ED, Labroo R. Metabolism of ketamine stereoisomers by human liver microsomes. Anesthesiology 1992 Dec;77(6):1201-7.
- Y Hijazi, C Bodonian, M Bolon, F Salord, R Boulieu. Pharmacokinetics and haemodynamics of ketamine in intensive care patients with brain or spinal cord injury. Br J Anaesth 2003;90(2):155-160.
- Christ G, Mundigler G, Merhaut C, Zehetgruber M, Kratochwill C, Heinz G, Siostrzonek P. Adverse cardiovascular effects of ketamine infusion in patients with catecholamine dependent heart failure. Anaesth Intensive Care. 1997 Jun;25(3):255-9.
- Sprung J, Schuetz SM, Stewart RW, Moravec CS. Effects of ketamine on the contractility of failing and nonfailing human heart muscle in vitro. Anesthesiology 1998 May;88(5):1202-10.
- Morray Jeffery P, Lynn Anne M, Stamm Stanley J, Herndon Paul S, Kawabori Isamu, Stevenson J Geoffrey. Hemodynamic effects of ketamine in children with congenital heart disease. Anesthesia & Analgesia. October 1984;63(10).
- Hornchen U, Tauberger G. Investigations on the mechanism of the effects of ketamine on circulation and respiration. Anaesthesist 1980 Oct;29(10):547-51.
- Boscan P, Pypendop BH, Solano AM, Ilkiw JE. Cardiovascular and respiratory effects of ketamine infusions in isoflurane anesthetized dogs before and during noxious stimulation. Am J Vet Res 2005 Dec;66(12):2122-9.
- Mortero RF, CLark LD, Tolan MM, Metz RJ, Tsueda K, Sheppard RA. The effects of small dose ketamine on propofol sedation: respiration, postoperative mood, perception, cognition and pain. Anesth Analg 2001 Jun;92(6):1465-9.
- E Pomarol Clotet, GD Honey, AR Absalom, PJ McKenna, ET Bullmore. Psychological effects of ketamine in healthy volunteers. The British ournal of Psychiatry 2006;189:173-179.
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Midazolam |
Metabolism and excretion |
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Effect on circulation |
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Effect on respiration |
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Effect on other organs |
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Drug interactions |
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Adverse effects |
Tenderness Pain during injection Redness Induration Phlebitis |
References:
- Riss, J.; Cloyd, J.; Gates, J.; Collins, S. (Aug 2008). “Benzodiazepines in epilepsy: pharmacology and pharmacokinetics.” Acta Neurol Scand 118 (2): 69–86.
- Mary F Paine, Danny D Shem, Kent L Kunze, James D Perkins, Christopher L Marsh, John P McVicar, Darlene M Barr, Bruce S Gillies, Kenneth E Thummel. First pass metabolism of midazolam by the numan intestine. Clinical Pharmacology & Therapeutics 1996;60:14-24.
- Marty J, Gauzit R, Lefevre P, Couderc E, Farinotti R, Henzel C, Desmonts JM. Effects of diazepam and midazolam on baroreflex control of heart rate and on sympathetic activity in humans. Anesth Analg 1986 feb;65(2):113-9.
- Win NN, Fukayama H, Kohase H, Umino M. The different effects of intravenous propofol and midazolam sedation on hemodynamic and heart rate variability. Anesth Analg 2005 Jul;101(1):97-102.
- Toshihiro Nakamura, Satoshi Kashimoto, AKihiko Nonaka, Teruo Kumazawa. Flumazenil does not antagonize the cardiac effects of midazolam in the isolated rat heart-lung preperation. Journal of anesthesia 1996;10(3):190-193.
- Forster Alain, Gardaz Jean Patrice, Suter Peter M, Gemperle Marcel. Respiratory depression by midazolam and diazepam. Dec 1980;53(6).
- KH Mak, YT Wang, TH Cheong, Sc Poh. The effect of oral midazolam and diazepam on respiration in normal subjects. Eur Respir J 1993;6:42-47.
- Freo U, Dam M, Ori C. The time dependent effects of midazolam on regional cerebral glucose metabolism in rats. Anesth Analg 2008 May;106(5):1516-23.
- Veselis Robert A, Reinsel Ruth A, Beattie Bradley J, Mawlawi Osama R, Feshchenko Vladimir A, Diresta Gene R, Larson Steven M, Blasberg Ronald G. Midazolam changes cerebral blood flow in discrete brain regions: An H2-150 Positron emission tomography study. Anesthesiology 1997;87(5):1106-1117.
- H Ito, Y Watanabe, A Isshiki, H Uchino. Neuroprotective properties of propofol and midazolam, but not pentobarbitol, on neuronal damage induced by forebrain ischemia, based on the GABAA receptors
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Remifentanil |
Metabolism and excretion |
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Effect on circulation |
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Effect on respiration |
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Effect on other organ system |
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Drug interactions |
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Adverse effects |
More coomon side effects are
Less common side effects
Rare side effects
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Precaution |
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Contraindications |
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References:
- T D Egan. Remifentanil: and esterase metabolized opioid. West J. Med 1997 March; 166(3):202.
- Talmage D Egan. Remifentanil phamacokinetics and pharmacodynamics. August 1995;29(2):80-94.
- Tirel O, Chanavaz C, Bansard JY, Carre F, Ecoffey C, Senhadji L, Wodey E. Effect of remifentanil with and without atropine on heart rate variability and RR interval in children. Anaesthesia 2005 Oct;60(10):982-9.
- Gimenes AM, de Araujo Aquiar AJ, Perri SH, de Paula Nogueira G. Effect of intravenous propofol and remifentanil on heart rate, blood pressure and nociceptive response in acepromazine premedicated dogs. Vet Anaesth Analg. 2011 Jan;38(1):54-62.
- Guignard Bruno, Menigaux Christophe, Dupont Xavier, Fletcher Dominique, Chauvin Marcel. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesthesia & analgesia. Jan 2000;90(1):161.
- Kojima A, Ito Y, Kitagawa H, Matsuura H, Nosaka S. Remifentanil has a minimal direct effect on sinoatrial node pacemaker activity in the guinea pig heart. Anesth Analg 2013 Nov;117(5):1072-7.
- Bernards CM, Knowlton SL, Schmidt DF, DePaso WJ, Lee MK, McDonald SB, Bains OS. Respiratory and sleep effects of remifentanil in volunteers with moderate obstructive sleep apnea. Anesthesiology 2009 Jan;110(1):41-9.
- TD Egan, SE Kern, KT Muir, J White. Remifentanil by bolus injection: a safety, pharmacokinetic, pharmacodynamic and age effect investigation in human volunteers. Br J Anaesth. 2004;92(3):335-343.
- Kan Randall E, Hughes Samuel C, Rosen Mark A, Kessin Charlize, Preston Paul G, Lobo Errol. Intravenous remifentanil: placental tranfer, maternal and neonatal effects. Anesthesiology. June 1998;88(6).
- K Engelhard, W Reeker, E Kochs, C Werner. The effect of remifentanil on intracranial pressure and cerebral blood flow velocity in patients with head trauma. Acta Anaesthesiol Scand 2004;48:396-399.
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Thiopental |
Metabolism and excretion |
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Effect on circulation |
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Effect on respiration |
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Effect on other organ system |
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Drug interactions |
guanadrel, guanethidine, mecamylamine, or trimethaphan or Diuretics or Hypotension-producing medications
clonidine, guanabenz, methyldopa, metyrosine, pargyline, and rauwolfia alkaloids
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Adverse effects |
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Contraindications |
Absolute contraindications
Relative contraindications
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Precaution |
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References:
- Winters Wd, Spector E, Wallach DP, Shideman FE. “Metabolism of thiopental-S35 and thiopental-2-C14 by a rat liver mince and identification of pentobarbital as a major metabolite”. J Pharmacol Exp Ther. July 1955;114 (3):343-57.
- Bory C, Chantin C, Boulieu R et al. Use of thiopental in man. Determination of this drug and its metabolites in plasma and urine by liquid phase chromatography and mass spectrometry. C R Acad Sci III, Sci Vie. 1986;303(1):7-12.
- Burch PG, Stanski DR. The role of metabolism and protein binding in thiopental anesthesia. Anetshesiology. 1983 Feb;58(2):146-52.
- Ilkiw JE, Haskins SC, Patz JD. Cardiovascular and respiratory effects of thiopental administration in hypovolemic dogs. Am J vet Res 1991 Apr;52(4):576-80.
- S Tsuchiya, N Kanaya, N Hirata, S Kurosawa, N Kamada, M Edanaga, M Nakayama, K Omote, A Namiki. Effects of thiopental on bispectral index and heart rate variability. European Journal of Anaesthesiology. 07/2006;23(6):454-9.
- YF Huang, RN Upton, Ec Gray, C Grant, D Zheng, GL Ludbrook. The effects of short intravenous infusions of thiopentone on myocardial function, blood flow and oxygen consumption in sheep. Anaesth Intens Care 1997;25:627-633.
- Bristow J David, Prys-Roberts Cedric, Fisher Anthony, Pickering Thomas G, Sleight Peter. Effects of anesthesia on baroreflex control of heart rate in man. Anesthesiology Nov 1969;31(5).
- A Masuda, Y Ito, A Haji, R Takeda. The influence of halothane and thiopental on respiratory related nerve activities in decerebrate cats. Acta Anaesthesiologica Scandinavica. Nov 1989;33(8):660-665.
- Michenfelder John D. The interdependency of cerebral functional and metabolic efefcts following massive doses of thiopental in the dog. Anesthesiology September 1974;41(3).
- Veselis RA, Feshchenko VA, Reinsel RA, Dnistrian AM, Beattie B, Akhurst TJ. Thiopental and propofol affect different regions of the brain at similar pharmacologic effects. Anesth Analg 2004 Aug;99(2):399-408.
- Antognini Joseph F, Carstens Earl, Atherley Richard BS. Does the immobilizing effect of thiopental in brain exceed that of halothane? Anetshesiology 2002;96(4):980-986.
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Methohexital |
Metabolism and excretion |
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Effect on circulation |
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Effect on respiration |
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Effect on other organ system |
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Drug interactions |
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Adverse effects |
Serious and rare side effects include:
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Contraindications |
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Precaution |
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References:
- Breimmer DD. Pharmacokinetics of methohexitone following intravenous infusion in humans. Br J Anaesth. 1976 Jul;48(7):643-9.
- Dirks B, Seibert A, Sperling G, Krieglstein J, Comparison of the effects of piracetam and methohexital on cerebral energy metabolism. Arzneimittel-Forschung. 1984;34(3):258-266.
- Hanke J, Krieglstein J. Mechanism of the protective effect of methohexitol on cerebral energy metabolism. Arzneimittelforschung. 1982;32(6):620-5.
- DOze Van A, Westphal Lynn M, White Paul F. Comparison of propofol with methohexital for outpatient anesthesia. Anesthesia & Analgesia. November 1986;65(11).
- Lepage JY, Pinaud ML, Helias JH, Cozian AY, Le Normand Y, Souron RJ. Left ventricular performance during propofol or methohexital anesthesia: isotropic and invasive cardiac monitoring. Anesth Analg. 1991 Jul;73(1):3-9.
- K Inoue, JO Arndt. Efferent vagal discharge and heart rate in response to methohexitone, althesin, ketamine and etomidate in cats. Br J Anaesth. 1982;54(10):1105-1116.
- Egbert Huettemann, Annabell Jung, Nicole van Hout, Samir G Sakka. Effects of popofol and methohexital on neutrophil function in cardiac surgical patients. Annals of cardiac Anaesthesia 2006;9:126-131.
- Campbell RL, Dionne RA, Gregg JM, Duncan G. Respiratory effects of fentanyl, diazepam and methohexital sedation. Journal of oral surgery. 1979;37(8):555-561.
- Choi Sunny D, Spaulding Barry C, Gross Jeffrey B, Apfelbaum Jeffrey L. Comparison of the ventilatory effects of etomidate and methohexital. Anesthesiology April 1985;62(4).
- FM Yatsu, I Diamond, C Graziano, P Lindquist. Experimental brain ischemia: Protection from irreversible damage with a rapid acting berbiturate (methohexital). Stroke 1972;3:726-732.
- Reddy RV, Moorthy SS, Dierdorf Stephen F, Deitch Robert D. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexitala and propofol. Anesthesia & Analgesia. Nov 1993;77(5).