RT Book, Section A1 Butterworth IV, John F. A1 Mackey, David C. A1 Wasnick, John D. SR Print(0) ID 1190604104 T1 Intravenous Anesthetics T2 Morgan & Mikhail’s Clinical Anesthesiology, 7e YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781260473797 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1190604104 RD 2024/03/28 AB KEY CONCEPTS Repetitive administration of highly lipid-soluble barbiturates (eg, infusion of thiopental for “barbiturate coma” and brain protection) saturates the peripheral compartments, minimizing any effect of redistribution and rendering the duration of action more dependent on elimination. This is an example of context sensitivity. Barbiturates constrict the cerebral vasculature, causing a decrease in cerebral blood flow, cerebral blood volume, and intracranial pressure. Although apnea may be relatively uncommon after benzodiazepine induction, even small intravenous doses of these agents have resulted in respiratory arrest. In contrast to other anesthetic agents, ketamine increases arterial blood pressure, heart rate, and cardiac output, particularly after rapid bolus injections. Induction doses of etomidate transiently inhibit enzymes involved in cortisol and aldosterone synthesis. When used for sedation in the intensive care unit, etomidate produced adrenocortical suppression. Propofol formulations can support the growth of bacteria, so sterile technique must be observed in preparation and handling. Propofol should be administered within 6 h of opening the ampule.