ICU/Hypnotics

 Thiopental
- 2.5% … 2.5g/100cm
- 500mg/20cm
- (3-5mg)/kg. * or 4-7mg/kg induction
- Increases heart rate.
- Decreases mean arterial blood pressure. Decrease ICP!
- Apnea and severe respiratory depression.
- rapid onset and rapid recovery.
- The most dangerous if given intra-arterial. Causes gangrenes.
- Appropriate with brain surgery, Brain protection, used in epileptics and decrease
basal metabolic rate of oxygen.

Propofol
- 10mg/1cm
- 2mg/kg. * or 1-2.5mg/kg
- highly lipophilic.
- drug of choice for daily care; because of rapid clearance, Rapid onset
- decrease nausea and vomiting and decreases ICP and Airway resistance.
- pain on injection. give lidocaine to alleviate it
- apnea and respiratory depression.

Used in total IV Anesthesia with analgesic (Remifentanil) in patient who are
contraindicated to use volatiles such as history of malignant hyperthermia or those
who are more susceptible to nausea and vomiting.

  Ketamine
- doesn’t cause hypotension or apnea(only minimal ventilatory depression)…
- rather hypertension, so It’s recommended in hypovolemic and burn patients.
-Good Analgesic effect!
- Increase heart rate and intracranial pressure. Thus contraindicated in head
trauma.
- Used in war emergencies. can be used without ventilators because it preserves
ventilation. Causes hypnosis and analgesia.
- 2mg/kg 1-2mg/kg induction * effective also in IM route.
- 50mg/cm
- in Gaza doctors used to dilute it 100mg in 10 cm means 10mg/1cm and used
diluted in pediatrics.
- smooth muscle relaxation and bronchodilatation.
- delirium! Use benzodiazepines to stop it.

Etomidate
- 0.2-0.3 mg/kg *
- Hemodynamically stable; used in heart disease patients. Decrease ICP.
- slightly decrease ventilatory drive.
- Adrenal suppression, The Most nausea and vomiting!

 Benzodiazepines
- sedative and anxiety relieve before operations 5mg IM Midazolam most
commonly used.
- In high doses respiratory depression and unconsciousness (hypotension).
- minimal decrease in blood pressure and cardiac output. Slight increase in
heart rate.
- Diazepam and lorazepam are water insoluble thus no rule in anesthesia.
Midazolam: rapid onset of action. 0.15-0.2 mg/kg, liver metabolism. The patient
could stay sedated for days (40h half-life). Metabolism in the liver.
- best premedicant (dormicum)
- Flumazenil (Anexate) antidote 0.2mg, short duration and should be given
repeatedly. And the patient should be admitted to ICU.

Volatiles
- Diffusion hypoxia, contraindicated in pneumothorax, Bone marrow depression
– N2O
- Hepatitis, Arrythmia with adrenaline, MAC 0.7 – Halothane
- irritant to upper Airway, MAC 1.15% – Isoflurane.
- Avoid in epileptics, MAC 1.7% – Enflurane.
All except N2O and O2 trigger malignant hyperthermia! And all volatiles are known
for nausea and vomiting!