Page 472 - Basic _ Clinical Pharmacology ( PDFDrive )

458 SECTION V Drugs That Act in the Central Nervous System

PREP AR A TIONS A V AIL ABLE *

GENERIC NAME AVAILABLE AS GENERIC NAME AVAILABLE AS
Desflurane Suprane Ketamine Generic, Ketalar
Dexmedetomidine Precedex Lorazepam Generic, Ativan
Diazepam Generic, Valium Methohexital Generic, Brevital
Droperidol Generic, Inapsine Midazolam Generic, Versed
Enflurane Enflurane, Ethrane Nitrous oxide (gas, supplied in blue Generic
Etomidate Generic, Amidate cylinders)
Fospropofol Lusedra Propofol Generic, Diprivan
Halothane Generic, Fluothane Sevoflurane Generic, Ultane
Isoflurane Generic, Forane, Terrell Thiopental Pentothal
* See Chapter 31 for names of opioid agents used in anesthesia.

REFERENCES Hirshey Dirksen SJ et al: Future directions in malignant hyperthermia research and
patient care. Anesth Analg 2011;113:1108.
Allaert SE et al: First trimester anesthesia exposure and fetal outcome. A review. Lugli AK, Yost CS, Kindler CH: Anesthetic mechanisms: Update on the challenge
Acta Anaesthesiol Belg 2007;58:119. of unravelling the mystery of anaesthesia. Eur J Anaesth 2009;26:807.
Ebert TJ et al: Desflurane-mediated sympathetic activation occurs in humans Olkkola KT, Ahonen J: Midazolam and other benzodiazepines. Handb Exp
despite preventing hypotension and baroreceptor unloading. Anesthesiology Pharmacol 2008;182:335.
1998;85:1227.
Eger EI II: Uptake and distribution. In: Miller RD (editor): Anesthesia, 7th ed. Reves JG et al: Intravenous anesthetics. In: Miller RD (editor): Anesthesia, 7th ed.
Churchill Livingstone, 2010.
Churchill Livingstone, 2010.
Eger EI II, Saidman LJ, Brandstater B: Minimum alveolar anesthetic concentra- Rudolph U et al: Sedatives, anxiolytics, and amnestics. In: Evers AS, Maze M
(editors): Anesthetic Pharmacology: Physiologic Principles and Clinical Practice.
tion: A standard of anesthetic potency. Anesthesiology 1965;26:756. Churchill Livingstone, 2004.
Fraga M et al: The effects of isoflurane and desflurane on intracranial pressure, Sjogren D, Lindahl SGE, Sollevi A: Ventilatory responses to acute and sustained
cerebral perfusion and cerebral arteriovenous oxygen content difference in hypoxia during isoflurane anesthesia. Anesth Analg 1998;86:403.
normocapnic patients with supratentorial brain tumors. Anesthesiology
2003;98:1085. Stoelting R, Hillier S: Barbiturates. In: Stoelting RK, Hillier SC (editors): Pharma-
Fragen RJ: Drug Infusions in Anesthesiology. Lippincott Williams & Wilkins, 2005. cology and Physiology in Anesthetic Practice. Lippincott Williams & Wilkins,
2005.
Hemmings HC et al: Emerging molecular mechanisms of general anesthetic Yasuda N et al: Kinetics of desflurane, isoflurane, and halothane in humans.
action. Trends Pharmacol Sci 2005;26:503.
Anesthesiology 1991;70:489.

C ASE STUD Y ANSWER

This patient presents with significant underlying cardiac of inhaled agent(s) would be made based on the desire to
risk and is scheduled to undergo major stressful surgery. maintain sufficient myocardial contractility, systemic blood
Balanced anesthesia would begin with intravenous agents pressure, and cardiac output for adequate perfusion of criti-
that cause minimal changes in blood pressure and heart rate cal organs throughout the operation. If the patient’s ischemic
such as a lowered dose of propofol or etomidate, combined pain has been chronic and severe, a low-dose ketamine
with potent analgesics such as fentanyl (see Chapter 31) to infusion may be administered for additional pain control.
block undesirable stimulation of autonomic reflexes. Main- Rapid emergence from the combined effects of the chosen
tenance of anesthesia could incorporate inhaled anesthetics anesthetic drugs, which would facilitate the patient’s return
that ensure unconsciousness and amnesia, additional intra- to a baseline state of heart function, breathing, and menta-
venous agents to provide intraoperative and postoperative tion, can be attained by understanding the known pharma-
analgesia, and, if needed, neuromuscular blocking drugs cokinetic properties of the anesthetic agents as presented in
(see Chapter 27) to induce muscle relaxation. The choice this chapter.