Barbiturates are ultra-short-acting IV anesthetics. Thiopental, a barbiturate, has high potency and lipid solubility for rapid entry to the brain. It is used for anesthesia induction and short surgical procedures, however it does not provide analgesia, just unconciousness. Its rapid recovery is due to redistribution to less vascular peripheral tissues from the CNS. Side effects include respiratory and cardiovascular depression.
Benzodiazapines include midazolam, which is the most common drug used for endoscopy, and may be used with gaseous anesthetics and narcotics as part of balanced anesthesia. It is used for preoperative sedation, and side effects include severe postoperative respiratory depression, amnesia, and lowered blood pressure.
Midazolam, used as amnestic with other anesthetics, has a side effect of severe postoperative respiratory depression.
Another side effect of benzodiazepines includes decreased blood pressure, and overdose may be treated with flumazenil.
Ketamine is classified as an arylcyclohexylamine, which is a class of PCP analogs that act as dissociative anesthetics.
Arylcyclohexylamines, including ketamine, are PCP analogs that act by blocking the effects of glutamic acid at NMDA receptors. This interferes with pain transmission in the spinal cord, and also leads to a dissociative amnesia.
These drugs are cardiovascular stimulants that increase cerebral blood flow and may result in disorientation, distortions of reality, and bad dreams, especially in adults.
Opioids include morphine and fentanyl, and are given preoperatively together with inhalation and IV anesthetics to help reduce pain.
Propofol is used for sedation in the ICU, for rapid anesthesia induction, and short procedures. In addition, it causes less postoperative nausea than thiopental.
Propofol potentiates GABA-A, and leads to rapid anesthesia induction.
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