1. Intravenous Anaesthetics Craigavon Area Hospital CT1 Education Series (Intro) Dr. Andrew Ferguson

5. Distribution & Elimination Dr. Andrew Ferguson

6. Single-injection Kinetics Dr. Andrew Ferguson

15. Single dose pharmacokinetics Dr. Andrew Ferguson Drug Redistribution T1/2 (min) Protein binding % VdSS l/kg Clearance ml/kg/min Elimination T1/2 (hrs) Thiopental 2-4 85 2.5 3.3 11 Methohexital 5-6 85 2.2 11 4 Propofol 2-4 98 2-10 20-30 4-23 Midazolam 7-15 94 1.1-1.7 6.4-11 1.7-2.6 Diazepam 10-15 98 0.7-1.7 0.2-0.5 20-50 Lorazepam 3-10 98 0.8-1.3 0.8-1.8 11-22 Etomidate 2-4 75 2.5-4.5 18-25 2.9-5.3 Ketamine 11-16 12 2.5-3.5 12-17 2-4

16. Induction Characteristics Dr. Andrew Ferguson Drug Induction dose (mg/kg) Onset (secs) Duration (mins) Excitation Injection pain Heart rate BP Thiopental 3-6 <30 5-10 + 0/+ + - Methohexital 1-3 <30 5-10 ++ + ++ - Propofol 1.5-2.5 15-45 5-10 + ++ 0/- -- Midazolam 0.2-0.4 30-90 10-30 0 0 0 0/- Diazepam 0.3-0.6 45-90 15-30 0 +/+++ 0 0/- Lorazepam 0.03-0.06 60-120 60-120 0 ++ 0 0/- Etomidate 0.2-0.3 15-45 3-12 +++ +++ 0 0 Ketamine 1-2 45-60 10-20 + 0 ++ ++

17. CNS effects of IV anaesthetics CMRO 2 = cerebral metabolic rate for oxygen CBF = cerebral blood flow CPP = cerebral perfusion pressure ICP = intracranial pressure Dr. Andrew Ferguson Drug CMRO 2 CBF CPP ICP Anticonvulsant Thiopental -- -- + -- Yes Methohexital -- -- + -- No Propofol -- -- - - Yes Etomidate -- -- + -- No Benzodiazepines - + 0 - Yes Ketamine + ++ + + No

18. CVS Effects of IV Anaesthetics Dr. Andrew Ferguson Drug MAP HR CO Contractility SVR Venous dilatation Thiopental - + - - + ++ Methohexital - ++ - - + + Propofol -- - - - -- ++ Etomidate 0 0 0 0 0 0 Diazepam 0/- + 0 0 -/0 + Midazolam 0/- + 0/- 0 -/0 + Ketamine ++ ++ + + + 0

19. RS Effects of IV Anaesthetics Dr. Andrew Ferguson Drug Ventilation Respiratory rate CO 2 response Hypoxia response Propofol --- -- --/--- Thiopental -- - -- Ketamine Unchanged Unchanged Unchanged ? Midazolam Unchanged Unchanged - - Etomidate - - -

20. Dr. Andrew Ferguson Propofol Thiopental Midazolam Ketamine Etomidate SBP Decrease Decrease 0/Decrease Increase Decrease Heart rate 0/Decrease Increase Unchanged Increase Decrease SVR Decrease Decrease Unchanged/Decrease Increase Decrease Ventilation Decrease Decrease Unchanged Unchanged Unchanged Resp rate Decrease Decrease Unchanged Unchanged Unchanged CO 2 response Decrease Decrease Unchanged Unchanged Unchanged CBF Decrease Decrease Unchanged Unchanged/Increase Unchanged CMRO 2 Decrease Decrease Unchanged Unchanged/increase Unchanged/Decrease ICP Decrease Decrease Unchanged Unchanged/Increase Unchanged Anticonvulsant Yes? Yes Yes Unclear Anxiolysis No No Yes No Yes? Analgesia No No No Yes No? Emergence delirium No No No Yes No N&V Decrease Unchanged Unchanged Increase Increase Adrenal suppression No No Yes? No No