Antiseptics
Class Summary
These agents inhibit growth of gram-positive and gram-negative bacteria.
Chlorhexidine gluconate (PerioGard, Peridex, Hibiclens, Avagard)
Chlorhexidine binds to negatively charged bacterial cell walls and extramicrobial complexes. It has bacteriostatic and bactericidal effects.
Povidone-iodine ophthalmic solution 5% (Betadine)
Povidone-iodine is an antibacterial agent with broad antibacterial and antiviral activity. No bacteria are known to be resistant to it.
Anxiolytics, Benzodiazepines
Class Summary
Administration of intravenous midazolam in the operating room can reduce anxiety, tachycardia, and hypertension.
Midazolam
Midazolam is a short-acting benzodiazepine with a rapid onset of action. It depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.
Temazepam (Restoril)
Temazepam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.
Opioid Analgesics
Class Summary
Induction of anesthesia is accomplished by using high doses of opioid (usually fentanyl or alfentanil) to maximize cardiovascular stability.
Fentanyl citrate (Duragesic, Abstral, Actiq, Fentora, Onsolis)
Fentanyl citrate is a synthetic opioid that has 75-200 times more potency and a much shorter half-life than morphine sulfate. It has fewer hypotensive effects than morphine and is safer in patients with hyperactive airway disease because of minimal or no associated histamine release. By itself, fentanyl citrate causes little cardiovascular compromise, although the addition of benzodiazepines or other sedatives may result in decreased cardiac output and blood pressure.
Fentanyl citrate is highly lipophilic and protein-bound. Prolonged exposure to it leads to accumulation of the drug in fat and delays the weaning process. Consider continuous infusion because of the medication's short half-life.
Anesthetic Agents
Class Summary
After standard monitoring equipment is attached and peripheral venous access achieved but before the arterial line is inserted, the midazolam or lorazepam dose is administered.
Propofol (Diprivan)
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.
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Tetracycline double-labeling on bone-osteoid surface as seen in fluorescent light. Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
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Electric drill for horizontal and vertical iliac crest biopsies. Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
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Modified Bordier trephine, from top to bottom, includes pointed trocar, outer guide or sleeve, trephine, and blunt extractor. Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
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Biopsy site is identified 2 cm posterior to anterior iliac crest (dotted line outlines iliac crest). Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
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Lidocaine (10%) is used to anesthetize skin, subcutaneous tissue, and periosteum. Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
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After incision is made, muscle and fascia are separated by blunt dissection until periosteum is exposed. Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
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Pointed obturator, together with outer guide, is inserted and applied firmly to exposed bone. Guide is rotated and implanted on lateral ilium. Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
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Trephine is inserted into outer guide and rotated counterclockwise with steady pressure until cutting action of trephine on bone is felt. Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
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Trephine advancing through full length of iliac crest. Image courtesy of Clin J Am Soc Nephrol 3:S164-S169, 2008.
