Monitoring:

• ECG
• O2 sats
• BP cuff

Induction

• Propafol +/- opiate (e.g. fentayl to increase sedation and provide some analgesia)
  • Major S/E: reduces vascular tone - SVR - affects CO and BP (hypotension)
  • stings as it travels up patient’s arm - use a large vein +/- lidocaine
  • metabolised by the liver, also uptake by fat and muscle
  • MOA: unclear - possible enhancement of GABA function
• Thiopentone
  • Used in RSI
  • Short acting barbiturate
  • causes significant post op nausea so its use is avoided
• Sevoflurane
  • Used for induction in paeds when unable to cannulate

Muscle paralysis

Depolarising:

• Suxamethonium
  • Very fast acting (30 secs), cleared within 7 mins
  • MOA: binds to post synaptic receptor causing depolarisation of the cell, this drug is not broken down by acetylcholinesterase therefore further acetylcholine cannot depolarise the cells as the receptors are used up (desensitisation)
  • cleared within 7 minutes by pseudocholinesterase

Non-depolarising agents (more commonly used):

• MOA: competetive antagonist at AChR
• Vecuronium
• Rocuronium
• Atracurium
  • Atracurium can cause bronchospasms so avoided in patients that are asthmatic
  • Broken down in the blood, so drug of choice if renal/liver impairment it used