- Author: Ashwin Pai, MBBS; Chief Editor: Kurt E Roberts, MD more...
The purpose of pharmacotherapy is to induce anesthesia.
General anesthesia is preferred for this procedure. After anesthesia is induced, a 16-French or 18-French Ryle tube is passed and kept on continuous drainage. The patient is then catheterized with a 14-French Foley catheter to monitor intraoperative and postoperative urine output.
Propofol is a phenolic compound unrelated to other types of anticonvulsants. It has general anesthetic properties when administered intravenously. Propofol IV produces rapid hypnosis, usually within 40 seconds. The effects are reversed within 30 minutes, following the discontinuation of infusion. Propofol has also been shown to have anticonvulsant properties.
Etomidate is a nonbarbiturate imidazole compound with sedative properties. It is short acting and has a rapid onset of action; the duration of action is dose dependent (15-30 min). Its most useful feature as an induction agent is that it produces deep sedation while causing minimal cardiovascular effects.
The major application of etomidate is induction for endotracheal intubation, particularly in patients with, or at risk for, hemodynamic compromise. Etomidate has been shown to depress adrenal cortical function; however, this effect is not significant clinically during short-term administration. Since the drug is mixed in propylene glycol, continuous infusion is not recommended.
Thiopental is a short-acting barbiturate sedative-hypnotic with rapid onset and a duration of action of 5-20 minutes. Like methohexital, it is most commonly used as an induction agent for intubation. To use thiopental as a sedative, titrate in dosage increments of 25 mg (adjust to lower dose in children).
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