IV Anesthetics?

[NurseDude1966]

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I am in nursing school and am doing an OR rotation now. As we are delving more into pharmagology in our pharm class now, I was really interested in the anesthetics/ meds they were using during the surgeries.

Apparently the hospital I am at still for certain cases utilizes barbiturate anethetics such as Methohexital sometimes... I know one of the reasons that propofol has become so popular is because is doesn't cause nausea and vomiting and causes amnesia which is beneficial in blocking the memory of any pain post op. Does methohexital and other barbiturate anesthetics induce the prefereable amnesia and reduced nausea and vomiting as well?

Also, I noticed in the ICU at this place, Precedex was used way more than Propofol as well. Does precedex have a favorable amnesia, muscle relaxant and low nausea and vomiting like propofol?

 

[dabears505]

I know some people may say methohexitol may be outdated, but at my hospital we haven't even gotten to that yet. We occasionally get to use ether soaked towels. To the Medicaid patients we are still using Budweiser and straps. Sometimes they do vomit with too much Budweiser. We do have a deal with the cafeteria for cheap eggs, we are looking into turning that into propofol in house

 

[NurseDude1966]

I know some people may say methohexitol may be outdated, but at my hospital we haven't even gotten to that yet. We occasionally get to use ether soaked towels. To the Medicaid patients we are still using Budweiser and straps. Sometimes they do vomit with too much Budweiser. We do have a deal with the cafeteria for cheap eggs, we are looking into turning that into propofol in house

Lol, I do like the humor but could you provide me with a serious response please?

 

[dabears505]

Sorry, but to be serious, I've found that I can get good muscle relaxation with preceded at extremely high doses that cause patients heart rates to decline quite a bit. I've noticed I get relaxation, but after like 10 minutes, they get stiff again. It does provide great amnesia and analgesia at those doses too. I never get complaints from those patients about anything

 

[NurseDude1966]

Sorry, but to be serious, I've found that I can get good muscle relaxation with preceded at extremely high doses that cause patients heart rates to decline quite a bit. I've noticed I get relaxation, but after like 10 minutes, they get stiff again. It does provide great amnesia and analgesia at those doses too. I never get complaints from those patients about anything

Precedex provides good amnesia and analgesia? What about methohexital?

 

[Twiggidy]

Precedex provides good amnesia and analgesia? What about methohexital?

That was the point of his joke. Very few hospitals are running around using methohexital unless they practice dark age anesthesiology.

 

[nimbus]

Is OP not in the United States?

 

[NurseDude1966]

That was the point of his joke. Very few hospitals are running around using methohexital unless they practice dark age anesthesiology.

Oh oh, I see!

 

[ethilo]

I am in nursing school and am doing an OR rotation now. As we are delving more into pharmagology in our pharm class now, I was really interested in the anesthetics/ meds they were using during the surgeries.

Apparently the hospital I am at still for certain cases utilizes barbiturate anethetics such as Methohexital sometimes... I know one of the reasons that propofol has become so popular is because is doesn't cause nausea and vomiting and causes amnesia which is beneficial in blocking the memory of any pain post op. Does methohexital and other barbiturate anesthetics induce the prefereable amnesia and reduced nausea and vomiting as well?

Also, I noticed in the ICU at this place, Precedex was used way more than Propofol as well. Does precedex have a favorable amnesia, muscle relaxant and low nausea and vomiting like propofol?

Methohexital is still used in electroconvulsive therapy because it doesn't raise the seizure threshold the way propofol does. Otherwise, propofol is largely preferred over it because there's less hangover and shorter context sensitive half time for infusions.

Also I think methohexital has some cross reactivity with some drugs that make it not IV compatible. If I remember right, rocuronium + methohexital precipitate into a solid on instant contact in iv tubing. Someone please correct me if I have it mixed up with something else that's similar.

Precedex is being used more over propofol for infusions in the ICU largely because of its reduced rates of ICU delirium.

 

[NurseDude1966]

Methohexital is still used in electroconvulsive therapy because it doesn't raise the seizure threshold the way propofol does. Otherwise, propofol is largely preferred over it because there's less hangover and shorter context sensitive half time for infusions.

Also I think methohexital has some cross reactivity with some drugs that make it not IV compatible. If I remember right, rocuronium + methohexital precipitate into a solid on instant contact in iv tubing. Someone please correct me if I have it mixed up with something else that's similar.

Precedex is being used more over propofol for infusions in the ICU largely because of its reduced rates of ICU delirium.

Thank you! Do they both cause the patient to forget and cause amnesia and reduced nausea and vomiting like propofol?

 

[DM27]

Methohexital we only have for ECT purposes. It will cause amnesia during the time of unconsciousness and varying degrees of a mild retro and anterograde amnesia in practice. In a book it will just be some mild post-consciousness anterograde amnesia.

Methohexital from my recollection is not preventative for PONV and may have a slightly increased incidence of PONV.

Precedex causes a sedation that is the closest we have to induction of physiologic sleep. As a result it does not cause a reliable anterograde or retrograde amnestic effect outside of the period where the patient is unconscious from its effects alone. It has a slight role in a reduced incidence of PONV but it depends where you look. I would be more inclined to call it PONV neutral.

 

[deleted875186]

Precedex is not a hypnotic. It does not reliably cause amnesia, and it does not cause muscle relaxation. It causes a sympathectomy, sedation, and possibly some analgesia. You can not produce general anesthesia with precedex alone in a healthy person in my experience, but you could obtains an ICU patient with it.

 

[coffeebythelake]

That was the point of his joke. Very few hospitals are running around using methohexital unless they practice dark age anesthesiology.

We only use methohexital for ECTs, and rarely for patients concerning for propofol allergy

 

[ethilo]

Thank you! Do they both cause the patient to forget and cause amnesia and reduced nausea and vomiting like propofol?

The GABA receptor is one of the primary receptors in the brain associated with learning, memory, interneuron communication, so you could reasonably make the assumption that meds agonizing or modulating this inhibitory receptor will cause a degree of amnesia: all barbiturates, benzos, and propofol.

Dexmedetomidine works to agonize the alpha 2 receptor which tends to decrease the sympathetic fight or flight response, hence a sleepy sedation without amnestic properties.

Ketamine is a dirty drug that primarily affects AMPA receptors and glutamate levels but to a lesser extent a bunch of other brain receptors too. It's "dirtiness" will essentially scramble the brain signals creating an altered experience (dissociation, or feeling like you are outside your own body or hallucinating you are somewhere or something other than what you are) without reliably causing amnesia until higher doses are used when it more consistently affects the GABA receptors.

 

[NurseDude1966]

We only use methohexital for ECTs, and rarely for patients concerning for propofol allergy

Does it cause amnesia? And do a lot of people throw up from it?

 

[coffeebythelake]

Does it cause amnesia? And do a lot of people throw up from it?

doesn't cause reliable amnesia
nausea neutral

 

[deleted875186]

doesn't cause reliable amnesia
nausea neutral

? Of course it causes amnesia. It’s a barbiturate.

 

[NurseDude1966]

? Of course it causes amnesia. It’s a barbiturate.

No he was referring to the precedex not the methohexital. But you just answered my question about the methohexital providing amnesia lol.

 

[pgg]

During the propofol shortage a few years back, we used methohexital as a substitute for inductions. It worked fine, except for cases that didn't get muscle relaxant. If you don't paralyze them, they get SO much myoclonic movement it's hard to prep or position for surgery. If you're trying to use an LMA, supporting spontaneous ventilation just doesn't work with all the hiccuping. The solution was just to paralyze everyone who got it.

All this of course is a big part of the reason we use it for ECTs. 🙂