Anaes SAQs · Intravenous induction agents
Choice of intravenous induction agent
The comparative induction-agent SAQ — the GABA-A-versus-NMDA dichotomy, the recovery-by-redistribution principle, the haemodynamic spectrum (propofol and thiopental fall the blood pressure, etomidate is neutral, ketamine is sympathomimetic), and the patient-to-agent selection logic for the shocked, the asthmatic and the head-injured patient. Anchored to the Sahinovic propofol PK/PD review, the Krasowski GABA-A-receptor paper, the Domino first-in-man ketamine paper, the Albert etomidate meta-analysis, the Goyal asthma review, the Hughes context-sensitive half-time paper, the Kam PRIS review, the Jensen porphyria review, the Sciorilli ketamine-TBI analysis, and the BIKe (ongoing) and KETA-BID (pilot, non-ICP outcome) protocols.
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Compare the intravenous induction agents (propofol, thiopental, etomidate, ketamine) with respect to mechanism, pharmacokinetics, haemodynamic effect and adverse-effect profile. Outline the principles that govern the choice of agent in (a) the shocked patient, (b) the severe asthmatic, and (c) the patient with raised intracranial pressure.
[5]References12ShowHide
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- [2]Krasowski MD, Koltchine VV, Rick CEM, et al. Propofol and other intravenous anesthetics have sites of action on the gamma-aminobutyric acid type A receptor distinct from that for isoflurane. Mol Pharmacol, 1998.PMID 9495821
- [3]Domino EF, Chodoff P, Corssen G. Pharmacologic effects of CI-581, a new dissociative anesthetic, in man. Clin Pharmacol Ther, 1965.PMID 14296024
- [4]Albert SG, Ariyan S, Rather A. The effect of etomidate on adrenal function in critical illness: a systematic review. Intensive Care Med, 2011.PMID 21373823
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- [7]Hughes MA, Glass PS, Jacobs JR. Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs Anesthesiology, 1992.PMID 1539843
- [8]Kam PC, Cardone D. Propofol infusion syndrome Anaesthesia, 2007.PMID 17567345
- [9]Sciorilli JV, et al. Is ketamine safe for traumatic brain injury? A systematic review and meta-analysis J Crit Care, 2026.PMID 41197253
- [10]Jensen NF, Fiddler DS, Striepe V. Anesthetic considerations in porphyrias Anesth Analg, 1995.PMID 7864431
- [11]Andreasen TH, Olsen MH, Gluud C, Lindschou J, et al. S-ketamine versus placebo for cortical spreading depolarisation in severe acute brain injury (KETA-BID): protocol for a pilot, randomised, blinded clinical trial BMJ Open, 2025.PMID 40721263
- [12]Andriazzi VH, et al. Etomidate Versus Ketamine for Emergency Intubation in Critically Ill Patients: An Updated Meta-Analysis and Systematic Review J Intensive Care Med, 2026.PMID 42299661