🧴 Propofol
- Mechanism: GABA receptor agonist → Causes neuronal inhibition
- Uses: Induction & maintenance of anesthesia
- Best for:
- Short procedures
- Day surgery
- TIVA (Total Intravenous Anesthesia)
- Special Considerations:
- Causes hypotension
- Pain on injection (Lidocaine prior to pushing may help but not always)
- Some preparations contain egg/soy, so be sure to ask about allergies!
- Clinical Use:
- Ideal for outpatient surgery (fast recovery)
- Used in procedures requiring frequent neurological assessments
- Avoid in elderly with cardiovascular compromise
🦄 Ketamine
- Mechanism: NMDA receptor antagonist → Blocks excitatory pathways
- Uses:
- Dissociative anesthesia (Patient is awake but unaware)
- Powerful analgesia
- Best for:
- Hemodynamically unstable patients
- Pediatric cases
- Patients with airway diseases (e.g., asthma)
- Special Considerations:
- Can cause emergence reactions (hallucinations, nightmares)
- Maintains airway reflexes
- Increases bronchial secretions
- Clinical Use:
- Perfect for trauma patients & burn victims
- Great for asthmatics due to bronchodilation
- Caution in psychiatric patients (may worsen symptoms)
🛡️ Etomidate
- Mechanism: GABA receptor modulator → Enhances inhibitory signals
- Uses:
- Induction of anesthesia
- Preferred in hemodynamically unstable patients
- Best for:
- Patients with cardiovascular instability
- Trauma cases
- Patients at risk for hypotension
- Special Considerations:
- Causes adrenal suppression (Even with ONE dose)
- Caution in sepsis patients (They rely on catecholamine synthesis to maintain BP)
- Clinical Use:
- Best for patients at risk of hypotension
- Avoid in long-term use due to adrenal suppression
📚 References
1️⃣ Miller RD. Miller’s Anesthesia. 9th ed. Philadelphia, PA: Elsevier; 2020.
2️⃣ Morgan GE, Mikhail MS, Murray MJ. Morgan & Mikhail’s Clinical Anesthesiology. 6th ed. New York, NY: McGraw Hill; 2018.
3️⃣ Steiner J. Anesthesia Made Easy: The Survival Guide to Make Your First Anesthesia Rotation a Success. 2nd ed. Independently Published; 2019.