**Week 2 - Exam 1 - Intravenous
Induction Agents Ch 9 in Nagelhout
Factors that decrease protein binding - Correct Answers ✅-
decreased lipid solubility
- increased drug concentration
- increased competition for binding sites with other drugs
Factors that increase protein binding - Correct Answers ✅-
increased pH (<8.0)
- increased protein concentration
May increase the effects of propofol - Correct Answers
✅decreased plasma protein levels from severe renal or
hepatic disease, or third trimester of pregnancy lowers drug
binding and increase free active friction
Propofol CNS effects: - Correct Answers ✅- reductions in:
- cerebral blood flow
- cerebral metabolic rate of oxygen consumption
- intracranial pressure
- cerebral perfusion pressure
Propofol CNS effects caused by: - Correct Answers ✅-
decreased mean arterial pressure
- depressed metabolic rate
- cerebral vasoconstriction
,**Week 2 - Exam 1 - Intravenous
Induction Agents Ch 9 in Nagelhout
Predictors of hypotension in propofol administration - Correct
Answers ✅- age greater than 50
- baseline mean arterial pressure less than 70 mmHg
- coadministration of high doses of fentanyl
- hypotension usually occurs within 10mins after induction
and is more prevalent in the second half of the 0-10min
interval
Primary reasons for propofol induced hypotension - Correct
Answers ✅- decreased sympathetic tone
- vasodilation
Respiratory effects of propofol - Correct Answers ✅-
transient respiratory depression
- decrease in tidal volume
- apnea - frequency and duration depression depend on dose,
speed of injection, patient characteristics, and presence other
meds
Two most effective interventions to reduce pain on injection
of propofol - Correct Answers ✅- use of antecubital vein
- pretreat with lidocaine 20-40mg in conjunction with venous
occlusion with the hand vein was chosen
, **Week 2 - Exam 1 - Intravenous
Induction Agents Ch 9 in Nagelhout
- intraarterial injection of propofol does not cause vascular
injury
Propofol obstetric use - Correct Answers ✅- passes easily
through parental barrier
- sedative effects occur in neonate when used for C section
Contraindications for propofol use - Correct Answers ✅-
allergy
- propofol infusion syndrome (with long term high dose
infusions)
- this is various metabolic derangements and organ failures
Risk factors for propofol infusion syndrome - Correct
Answers ✅- young age
- dose greater than 4-5mg/kg/hr
- duration greater than 48hrs
- critical illness
- high fat - low carb intake
- inborn errors of mitochondrial fatty acid oxidation
- concomitant catecholamine infusion
- steroid administration
- acute inflammatory disease
- acute neurologic disease
Induction Agents Ch 9 in Nagelhout
Factors that decrease protein binding - Correct Answers ✅-
decreased lipid solubility
- increased drug concentration
- increased competition for binding sites with other drugs
Factors that increase protein binding - Correct Answers ✅-
increased pH (<8.0)
- increased protein concentration
May increase the effects of propofol - Correct Answers
✅decreased plasma protein levels from severe renal or
hepatic disease, or third trimester of pregnancy lowers drug
binding and increase free active friction
Propofol CNS effects: - Correct Answers ✅- reductions in:
- cerebral blood flow
- cerebral metabolic rate of oxygen consumption
- intracranial pressure
- cerebral perfusion pressure
Propofol CNS effects caused by: - Correct Answers ✅-
decreased mean arterial pressure
- depressed metabolic rate
- cerebral vasoconstriction
,**Week 2 - Exam 1 - Intravenous
Induction Agents Ch 9 in Nagelhout
Predictors of hypotension in propofol administration - Correct
Answers ✅- age greater than 50
- baseline mean arterial pressure less than 70 mmHg
- coadministration of high doses of fentanyl
- hypotension usually occurs within 10mins after induction
and is more prevalent in the second half of the 0-10min
interval
Primary reasons for propofol induced hypotension - Correct
Answers ✅- decreased sympathetic tone
- vasodilation
Respiratory effects of propofol - Correct Answers ✅-
transient respiratory depression
- decrease in tidal volume
- apnea - frequency and duration depression depend on dose,
speed of injection, patient characteristics, and presence other
meds
Two most effective interventions to reduce pain on injection
of propofol - Correct Answers ✅- use of antecubital vein
- pretreat with lidocaine 20-40mg in conjunction with venous
occlusion with the hand vein was chosen
, **Week 2 - Exam 1 - Intravenous
Induction Agents Ch 9 in Nagelhout
- intraarterial injection of propofol does not cause vascular
injury
Propofol obstetric use - Correct Answers ✅- passes easily
through parental barrier
- sedative effects occur in neonate when used for C section
Contraindications for propofol use - Correct Answers ✅-
allergy
- propofol infusion syndrome (with long term high dose
infusions)
- this is various metabolic derangements and organ failures
Risk factors for propofol infusion syndrome - Correct
Answers ✅- young age
- dose greater than 4-5mg/kg/hr
- duration greater than 48hrs
- critical illness
- high fat - low carb intake
- inborn errors of mitochondrial fatty acid oxidation
- concomitant catecholamine infusion
- steroid administration
- acute inflammatory disease
- acute neurologic disease
