Abstract
Varying depths of sedation through general anesthesia may be required in critically ill patients during surgical interventions, non-invasive procedures such as magnetic resonance imaging, or invasive procedures such as central line placement. During such procedures, a variety of agents may be chosen to provide the conditions required for a surgical procedure including amnesia, analgesia, muscle relaxation and control of the sympathetic nervous system. The agents used for the induction and maintenance of general anesthesia may be broadly classified into either inhalational (volatile) or intravenous agents. In addition to their use in the operating room for the provision of general anesthesia, both the intravenous and volatile agents may be used outside of the operating for either their sedative properties or even occasionally for their therapeutic effects. Examples include the use of propofol for sedation during magnetic resonance imaging, pentobarbital to control intracranial pressure (ICP) in patients with traumatic brain injury, or the administration of isoflurane for the treatment of status asthmaticus. The following chapter reviews the history, pharmacology, and end-organ effects of the inhalational and intravenous anesthetic agents.
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References
Robbins J. Preliminary studies of the activity of fluorinated hydrocarbons. J Pharmacol Exp Ther. 1946;86:197–200.
Krantz Jr JC, Carr J, Lu G, et al. Anesthesia: anesthetic action of trifluoroethyl vinyl ether. J Pharmacol Exp Ther. 1953;108:488–92.
Tucker WK, Munson ES, Holaday DA, et al. Hepatorenal toxicity following fluroxene anesthesia. Anesthesiology. 1973;39:104–7.
Johnston RR, Cromwell TH, Eger 2nd EI, et al. The toxicity of fluroxene in animals and man. Anesthesiology. 1973;38:313–9.
Harris JA, Cromwell TH. Jaundice following fluroxene anesthesia. Anesthesiology. 1972;37:462–3.
Raventos J. Action of fluothane – new volatile anesthetic. Br J Pharmacol. 1956;11:394–7.
Eger II EI, Bahlman S. Is end-tidal anesthetic partial pressure an accurate measure of the arterial anesthetic partial pressure? Anesthesiology. 1971;35:301–3.
Le Dez K, Lerman J. The minimum alveolar concentration (MAC) of isoflurane in preterm neonates. Anesthesiology. 1987;67:301–7.
Gregory G, Eger 2nd EI, Munson ES. The relationship between age and halothane requirement in man. Anesthesiology. 1969;30:488–91.
Eckenhoff R, Constant I, Seeman R, Murat I. Sevoflurane and epleptiform EEG changes. Pediatr Anesth. 2005;15:266–74.
Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004;61:1254–9125.
Hilz MJ, Bauer J, Claus D, Stefan H, Neundörfer B. Isoflurane anaesthesia in the treatment of convulsive status epilepticus. J Neurol. 1992;239:135–7.
Sponheim S, Skraastad O, Helseth E, et al. Effects of 0.5 and 1.0 MAC isoflurane, sevoflurane and desflurane on intracranial and cerebral perfusion pressures in children. Acta Anaesthesiol Scand. 2003;47:932–8.
Adams RW, Cucchiara RF, Gronert GA, Messick JM, Michenfelder JD. Isoflurane and cerebrospinal fluid pressure in neurosurgical patients. Anesthesiology. 1981;54:97–9.
Drummond JC, Todd MM, Scheller MS, Shapiro HM. A comparison of the direct cerebral vasodilating potencies of halothane and isoflurane in the New Zealand White Rabbit. Anesthesiology. 1986;65:462–7.
Morray JP, Geiduschek JM, Ramamoorthy C, et al. Anesthesia-related cardiac arrest in children: initial findings of the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesthesiology. 2000;93:6–14.
Roodman S, Bothwell M, Tobias JD. Bradycardia with sevoflurane induction in patients with trisomy 21. Paediatr Anaesth. 2003;13:538–40.
Bai W, Voepel-Lewis T, Malviya S. Hemodynamic changes in children with Down syndrome during and following inhalation induction of anesthesia with sevoflurane. J Clin Anesth. 2010;22:592–7.
Benumof JL, Augustine SD, Gibbons JA. Halothane and isoflurane only slightly impair arterial oxygenation during one lung ventilation in patients undergoing thoracotomy. Anesthesiology. 1987;67:910–5.
Hirshman CA, Edelstein G, Peetz S, et al. Mechanism of action of inhalational anesthesia on airways. Anesthesiology. 1982;56:107–11.
Watanabe K, Mizutani T, Yamashita S, Tatekawa Y, Jinbo T, Tanaka M. Prolonged sevoflurane inhalation therapy for status asthmaticus in an infant. Paediatr Anaesth. 2008;18:543–5.
Tobias JD. Inhalational anesthesia for the treatment of status asthmaticus. J Intensive Care Med. 2009;24:361–71.
Warner DO, Vettermann J, Brichant JF, et al. Direct and neurally mediated effects of halothane on pulmonary resistance in vivo. Anesthesiology. 1990;72:1057–63.
Katoh T, Ikeda K. A comparison of sevoflurane with halothane, enflurane, and isoflurane on bronchoconstriction caused by histamine. Can J Anaesth. 1994;41:1214–9.
Satoh H, Gillette JR, Takemura T, et al. Investigation of the immunological basis of halothane-induced hepatotoxicity. Adv Exp Med Biol. 1986;197:657–773.
Kenna JG, Neuberger J, Williams R. Evidence for expression in human liver of halothane-induced neoantigens recognized by antibodies in sera from patients with halothane hepatitis. Hepatology. 1988;8:1635–41.
Subcommittee on the National Halothane Study of the Committee on Anesthesia. Possible association between halothane anesthesia and postoperative hepatic necrosis. JAMA. 1966;197:775–88.
Kenna JG, Jones RM. The organ toxicity of inhaled anesthetics. Anesth Analg. 1995;81(suppl):S51–66.
Brown Jr BR, Gandolfi AJ. Adverse effects of volatile anesthetics. Br J Anaesth. 1987;59:14–23.
Pohl LR, Satoh H, Christ DD, et al. The immunologic and metabolic basis of drug hypersensitivities. Annu Rev Pharmacol. 1988;28:367–87.
Wark HJ. Postoperative jaundice in children - the influence of halothane. Anaesthesia. 1983;38:237–42.
Warner LO, Beach TP, Garvin JP, et al. Halothane and children: the first quarter century. Anesth Analg. 1984;63:838–40.
Mazze RI, Calverley RK, Smith NT. Inorganic fluoride nephrotoxicity: prolonged enflurane and halothane anesthesia in volunteers. Anesthesiology. 1977;46:265–71.
Morio M, Fujii K, Satoh N, et al. Reaction of sevoflurane and its degradation products with soda lime. Toxicity of the byproducts. Anesthesiology. 1992;77:1155–64.
Frink EJ Jr, Malan TP, Morgan SE, et al. Quantification of the degradation products of sevoflurane in two CO2 absorbents during low-flow anesthesia in surgical patients. 1992;77:1064–9.
Mazze RI. The safety of sevoflurane in humans. Anesthesiology. 1992;77:1062–6.
Hevers W, Lüddens H. The diversity of GABA-A receptors. Pharmacological and electrophysiological properties of GABA-A channel subtypes. Mol Neurobiol. 1998;18:35–86.
Concas A, Santoro G, Mascia MP, et al. The general anesthetic propofol enhances the function of alpha aminobutyric acid- coupled chloride channel in the rate cerebral cortex. J Neurochem. 1990;55:2135–40.
Ho IK, Harris RA. Mechanism of action of barbiturates. Annu Rev Pharmacol Toxicol. 1981;21:83–111.
Johnston GA, Willow M. GABA and barbiturate receptors. Trends Pharmacol Sci. 1982;3:328–30.
Olsen RW. Drug interactions at the GABA receptor-ionophore complex. Annu Rev Pharmacol Toxicol. 1982;22:245–77.
MacDonald JF, Miljkovic Z, Pennefather P. Use-dependent block of excitatory amino acid currents in cultured neurons by ketamine. J Neurophysiol. 1987;58:251–66.
Mayer ML, Westbrook GL, Vyklicky L. Sites of antagonist action on N-methyl-d-aspartatic acid receptors studied using fluctuation analysis and a rapid perfusion technique. J Neurophysiol. 1988;60:645–63.
Vincent JP, Cavey D, Kamenka JM, et al. Interaction of phencyclinidines with the muscarinic and opiate receptors in the central nervous system. Brain Res. 1978;152:176–82.
Astrup J, Sorensen PM, Sorensen HR. Inhibition of cerebral oxygen and glucose consumption in the dog by hypothermia, pentobarbital and lidocaine. Anesthesiology. 1981;55:263–8.
Cormio M, Gopinath SP, Valadka A, et al. Cerebral hemodynamic effects of pentobarbital coma in head-injured patients. J Neurotrauma. 1999;16:927–36.
Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999;40:759–62.
Holmes GL, Riviello Jr JJ. Midazolam and pentobarbital for refractory status epilepticus. Pediatr Neurol. 1999;20:259–64.
Ishimaru H, Takahashi A, Ikarashi Y, et al. Effects of MK-801 and pentobarbital on cholinergic terminal damage and delayed neuronal death in the ischemic gerbil hippocampus. Brain Res Bull. 1997;43:81–5.
Morimoto Y, Morimoto Y, Nishihira J, et al. Pentobarbital inhibits apoptosis in neuronal cells. Crit Care Med. 2000;28:1899–904.
Audenaert SM, Montgomery CL, Thompson DE, et al. A prospective study of rectal methohexital: efficacy and side effects in 648 cases. Anesth Analg. 1995;81:957–61.
Nguyen MT, Greenburg SB, Fitzhugh KR, et al. Pediatric imaging: sedation with an injection formulation modified for rectal administration. Radiology. 2001;221:760–2.
Alp H, Orbak Z, Guler I, et al. Efficacy and safety of rectal thiopental, intramuscular cocktail and rectal midazolam for sedation in children undergoing neuroimaging. Pediatr Int. 2002;44:628–34.
Rubin JT, Towbin RB, Bartko M, Baskin KM, Cahill AM, Kaye RD. Oral and intravenous caffeine for treatment of children with post-sedation paradoxical hyperactivity. Pediatr Radiol. 2004;34:980–4.
Kay B, Rolly G. I.C.I. 35868—the effect of a change of formulation on the incidence of pain after intravenous injection. Acta Anaesthesiol Belg. 1977;28:317–22.
Bengalorkar GM, Bhuvana K, Sarala N, Kumar T. Fospropofol: clinical pharmacology. J Anaesthesiol Clin Pharmacol. 2011;27:79–83.
Sebel PS, Lowdon JD. Propofol: a new intravenous anesthetic. Anesthesiology. 1989;71:260–77.
Harris CE, Grounds RM, Murray AM, et al. Propofol for long-term sedation in the intensive care unit. A comparison with papaveretum and midazolam. Anaesthesia. 1990;45:366–72.
Beller JP, Pottecher T, Lugnier A, et al. Prolonged sedation with propofol in ICU patients: recovery and blood concentration changes during periodic interruption in infusion. Br J Anaesth. 1988;61:583–8.
Ronan KP, Gallagher TJ, George B, Hamby B. Comparison of propofol and midazolam for sedation in intensive care unit patients. Crit Care Med. 1995;23:286–93.
Simons PJ, Cockshott ID, Douglas EJ, Gordon EA, Hopkins K, Rowland M. Disposition in male volunteers of a subanaesthetic intravenous dose of an oil in water emulsion of 14C-propofol. Xenobiotica. 1988;18:429–40.
Veroli P, O’Kelly B, Bertrand F, et al. Extrahepatic metabolism of propofol in man during the anhepatic phase of orthotopic liver transplantation. Br J Anaesth. 1992;68:183–6.
Tritapepe L, Voci P, Marino P, et al. Calcium chloride minimizes the hemodynamic effects of propofol in patients undergoing coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 1999;13:150–3.
Sochala C, Van Deenen D, De Ville A, Govaerts MJM. Heart block following propofol in a child. Paediatr Anaesth. 1999;9:349–51.
Egan TD, Brock-Utne JG. Asystole and anesthesia induction with a fentanyl, propofol, and succinylcholine sequence. Anesth Analg. 1991;73:818–20.
Kannan S, Sherwood N. Termination of supraventricular tachycardia by propofol. Br J Anaesth. 2002;88:874–5.
Eames WO, Rooke GA, Sai-Chuen R, Bishop MJ. Comparison of the effects of etomidate, propofol, and thiopental on respiratory resistance after tracheal intubation. Anesthesiology. 1996;84:1307–11.
Pizov R, Brown RH, Weiss YS, et al. Wheezing during induction of general anesthesia in patients with and without asthma. A randomized, blinded trial. Anesthesiology. 1995;82:1111–6.
Chih-Chung L, Ming-Hwang S, Tan PPC, et al. Mechanisms underlying the inhibitory effect of propofol on the contraction of canine airway smooth muscle. Anesthesiology. 1999;91:750–9.
Pedersen CM, Thirstrup S, Nielsen-Kudsk JE. Smooth muscle relaxant effects of propofol and ketamine in isolated guinea-pig tracheas. Eur J Pharmacol. 1993;238:75–80.
Brown RH, Greenberg RS, Wagner EM. Efficacy of propofol to prevent bronchoconstriction. Anesthesiology. 2001;94:851–5.
Rieschke P, LeFleur BJ, Janicki PK. Effects of EDTA and sulfite-containing formulations of propofol on respiratory system resistance after tracheal intubation in smokers. Anesthesiology. 2003;98:323–8.
Hemelrijck JV, Fitch W, Mattheussen M, Van Aken H, Plets C, Lauwers T. Effect of propofol on cerebral circulation and autoregulation in the baboon. Anesth Analg. 1990;71:49–54.
Nimkoff L, Quinn C, Silver P, Sagy M. The effects of intravenous anesthetic agents on intracranial pressure and cerebral perfusion pressure in two feline models of brain edema. J Crit Care. 1997;12:132–6.
Watts ADJ, Eliasziw M, Gelb AW. Propofol and hyperventilation for the treatment of increased intracranial pressure in rabbits. Anesth Analg. 1998;87:564–8.
Herregods L, Verbeke J, Rolly G, Colardyn F. Effect of propofol on elevated intracranial pressure. Preliminary results. Anaesthesia. 1988;43(suppl):107–9.
Pinaud M, Lelausque J, Chetanneau A, Fauchoux N, Menegalli D, Souron R. Effects of propofol on cerebral hemodynamics and metabolism in patients with brain trauma. Anesthesiology. 1990;73:404–9.
Mangez JF, Menguy E, Roux P. Sedation par propofol a debit constant chez le traumatise cranien. Resultas preliminaires. Ann Fr Anesth Reanim. 1987;6:336–7.
Ravussin P, Guinard JP, Ralley F, Thorin D. Effect of propofol on cerebrospinal fluid pressure and cerebral perfusion pressure in patients undergoing craniotomy. Anaesthesia. 1988;43(suppl):107–9.
Farling PA, Johnston JR, Coppel DL. Propofol infusion for sedation of patients with head injury in intensive care. Anaesthesia. 1989;44:222–6.
Yamaguchi S, Midorikawa Y, Okuda Y, et al. Propofol prevents delayed neuronal death following transient forebrain ischemia in gerbils. Can J Anaesth. 1999;46:593–8.
Young Y, Menon DK, Tisavipat N, et al. Propofol neuroprotection in a rat model of ischaemia reperfusion injury. Eur J Anesthesiol. 1997;14:320–6.
Fox J, Gelb AW, Enns J, et al. The responsiveness of cerebral blood flow to changes in arterial carbon dioxide is maintained during propofol-nitrous oxide anesthesia in humans. Anesthesiology. 1992;77:453–6.
Trotter C, Serpell MG. Neurological sequelae in children after prolonged propofol infusions. Anaesthesia. 1992;47:340–2.
Saunders PRI, Harris MNE. Opisthotonic posturing and other unusual neurological sequelae after outpatient anesthesia. Anaesthesia. 1992;47:552–7.
Finley GA, MacManus B, Sampson SE, Fernandez CV, Retallick I. Delayed seizures following sedation with propofol. Can J Anaesth. 1993;40:863–5.
Hewitt PB, Chu DLK, Polkey CE, Binnie CD. Effect of propofol on the electrocorticogram in epileptic patients undergoing cortical resection. Br J Anaesth. 1999;82:199–202.
McBurney JW, Teiken PJ, Moon MR. Propofol for treating status epilepticus. J Epilepsy. 1994;7:21–2.
Lowenstein DH, Alldredge BK. Status epilepticus. New Engl J Med. 1998;338:970–6.
Laxenaire MC, Mata-Bermejo E, Moneret-Vautrin DA, Gueant JL. Life-threatening anaphylactoid reactions to propofol. Anesthesiology. 1992;77:275–80.
Gottardis M, Khunl-Brady KS, Koller W, et al. Effect of prolonged sedation with propofol on serum triglyceride and cholesterol concentrations. Br J Anaesth. 1989;62:393–6.
Murphy A, Campbell DE, Baines D, Mehr S. Allergic reactions to propofol in egg-allergic children. Anesth Analg. 2011;113:140–4.
Griffin J, Ray T, Gray B, et al. Pain on injection of propofol: a thiopental/propofol mixture versus a lidocaine/propofol mixture. Am J Pain Manag. 2002;12:45–9.
Tobias JD. Prevention of pain associated with the administration of propofol in children: lidocaine versus ketamine. Am J Anesthesiol. 1996;23:231–2.
Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg. 2000;90:963–9.
Mangar D, Holak EJ. Tourniquet at 50 mmHg followed by intravenous lidocaine diminishes hand pain associated with propofol injection. Anesth Analg. 1992;74:250–2.
Haugen RD, Vaghadia H, Waters T, Merick PM. Thiopentone pretreatment for propofol injection pain in ambulatory patients. Can J Anaesth. 1993;42:1108–12.
Sosis MB, Braverman B. Growth of Staphylococcus aureus in four intravenous anesthetics. Anesth Analg. 1993;77:766–8.
Postsurgical infections associated with extrinsically contaminated intravenous anesthetic agent – California, Illinois, Maine, and Michigan, 1990. MMWR 1990;39:426–427, 433.
Fassoulaki A, Paraskeva A, Papilas K, Patris K. Hypnotic and cardiovascular effects of proprietary and generic propofol formulations do not differ. Can J Anaesth. 2001;48:459–61.
Parke TJ, Stevens JE, Rice ASC, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. Br Med J. 1992;305:613–6.
Strickland RA, Murray MJ. Fatal metabolic acidosis in a pediatric patient receiving an infusion of propofol in the intensive care unit: is there a relationship? Crit Care Med. 1995;23:405–9.
Hanna JP, Ramundo ML. Rhabdomyolysis and hypoxia associated with prolonged propofol infusion. Neurology. 1998;50:301–3.
Bray RJ. Propofol infusion syndrome in children. Paediatr Anaesth. 1998;8:491–9.
Spitzfadden AC, Jimenez DF, Tobias JD. Propofol for sedation and control of intracranial pressure in children. Pediatr Neurosurg. 1999;31:194–200.
Cremer OL, Bouman EAC, Kruijswijk JE, et al. Long-term propofol infusion and cardiac failure in adult head-injured patients. Lancet. 2000;357:117–8.
Perrier ND, Baerga-Varela Y, Murray M. Death related to propofol use in an adult. Crit Care Med. 2000;28:3071–4.
Schenkman KA, Yan S. Propofol impairment of mitochondrial respiration in isolated perfused guinea pig hearts determined by reflectance spectroscopy. Crit Care Med. 2000;28:172–7.
Wolf A, Weir P, Segar P, et al. Impaired fatty acid oxidation in propofol infusion syndrome. Lancet. 2001;357:606–7.
Withington DE, Decell MK, Al Ayed T. A case of propofol toxicity: further evidence for a causal mechanism. Pediatr Anesth. 2004;14:505–8.
Cravens GT, Pcker DL, Johnson ME. Incidence of propofol infusion syndrome during noninvasive radiofrequency ablation for atrial flutter or fibrillation. Anesthesiology. 2007;106:1134–8.
Domino EF, Chodoff P, Corssen G. Pharmacologic effects of CI-581, a new dissociative anesthetic in man. Clin Pharmacol Ther. 1965;6:279–91.
Tobias JD. End-tidal carbon dioxide monitoring during sedation with a combination of midazolam and ketamine for children undergoing painful, invasive procedures. Pediatr Emerg Care. 1999;15:173–5.
Chernow B, Laker R, Creuss D, et al. Plasma, urine, and cerebrospinal fluid catecholamine concentrations during and after ketamine sedation. Crit Care Med. 1982;10:600–3.
Wayman K, Shoemaker WC, Lippmann M. Cardiovascular effects of anesthetic induction with ketamine. Anesth Analg. 1980;59:355–8.
Spotoft H, Korshin JD, Sorensen MB, et al. The cardiovascular effects of ketamine used for induction of anesthesia in patients with valvular heart disease. Can Anaesth Soc J. 1979;26:463–7.
Adriaenssens G, Vermeyen KM, Hoffmann VLH, Mertens E, Adriaensen HF. Postoperative analgesia with iv patient-controlled morphine: effect of adding ketamine. Br J Anaesth. 1999;83:393–6.
Jahangir SM, Islam F, Aziz L. Ketamine infusion for postoperative analgesia in asthmatics: comparison with intermittent meperidine. Anesth Analg. 1993;76:45–9.
Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology. 2005;102:211–20.
Lahtinen P, Kokki H, Hakala T, et al. S(+) ketamine as an analgesic adjunct reduces opioid consumption after cardiac surgery. Anesth Analg. 2004;99:1295–301.
Engelhardt T, Zaarour C, Naser B, Pehora C, de Ruiter J, Howard A, Crawford MW. Intraoperative low-dose ketamine does not prevent a remifentanil-induced increase in morphine requirement after pediatric scoliosis surgery. Anesth Analg. 2008;107:1170–5.
Mankikian B, Cantineau JP, Sartene R, et al. Ventilatory and chest wall mechanics during ketamine anesthesia in humans. Anesthesiology. 1986;65:492–9.
Von Ungern-Sternberg BS, Regli A, Frei FJ, et al. A deeper level of ketamine anesthesia does not affect functional residual capacity and ventilation distribution in healthy preschool children. Pediatr Anesth. 2007;17:1150–5.
Hirshman CA, Downes H, Farbood A, Bergman NA. Ketamine block of bronchospasm in experimental canine asthma. Br J Anaesth. 1979;51:713–8.
Bourke DL, Malit LA, Smith TC. Respiratory interactions of ketamine and morphine. Anesthesiology. 1987;66:153–6.
Lanning CF, Harmel MH. Ketamine anesthesia. Annu Rev Med. 1975;26:137–41.
Taylor PA, Towey RM. Depression of laryngeal reflexes during ketamine administration. Br Med J. 1971;2:688–9.
Marhofer P, Freitag H, Hochtl A, et al. S(+) ketamine for rectal premedication in children. Anesth Analg. 2001;92:62–5.
Weksler N, Ovadia L, Muati G, et al. Nasal ketamine for paediatric premedication. Can J Anaesth. 1993;40:119–21.
Weber F, Wulf H, el Saeidi G. Premedication with nasal s-ketamine and midazolam provides good conditions for induction of anaesthesia in preschool children. Can J Anaesth. 2003;50:470–5.
Koinig H, Marhoger P. S(+) ketamine in paediatric anaesthesia. Paediatr Anaesth. 2003;13:185–7.
Gooding JM, Dimick AR, Travakoli M, et al. A Physiologic analysis of cardiopulmonary responses to ketamine anesthesia in non-cardiac patients. Anesth Analg. 1977;56:813–6.
Morray JP, Lynn AM, Stamm SJ, et al. Hemodynamic effects of ketamine in children with congenital heart disease. Anesth Analg. 1984;63:895–9.
Hickey PR, Hansen DD, Cramolini GM, et al. Pulmonary and systemic hemodynamic responses to ketamine in infants with normal and elevated pulmonary vascular resistance. Anesthesiology. 1985;62:287–93.
Wolfe RR, Loehr JP, Schaffer MS, Wiffins Jr JW. Hemodynamic effects of ketamine, hypoxia, and hyperoxia in children with surgically treated congenital heart disease residing ≥1,200 meters above sea level. Am J Cardiol. 1991;67:84–7.
Williams GD, Philip BM, Chu LF, et al. Ketamine does not increase pulmonary vascular resistance in children with pulmonary hypertension undergoing sevoflurane anesthesia and spontaneous ventilation. Anesth Analg. 2007;105:1578–84.
Singh A, Girotra S, Mehta Y, Radhakrishnan S, Shrivastava S. Total intravenous anesthesia with ketamine for pediatric interventional cardiac procedures. J Cardiothorac Vasc Anesth. 2000;14:36–9.
Lebovic S, Reich DL, Steinberg G, Vela FP, Silvay G. Comparison of propofol versus ketamine for anesthesia in pediatric patients undergoing cardiac catheterization. Anesth Analg. 1992;74:490–4.
Shapiro HM, Wyte SR, Harris AB. Ketamine anesthesia in patients with intracranial pathology. Br J Anaesth. 1972;44:1200–4.
Gardner AE, Dannemiller FJ, Dean D. Intracranial cerebrospinal fluid pressure in man during ketamine anesthesia. Anesth Analg. 1972;51:741–5.
Reicher D, Bhalla P, Rubinstein EH. Cholinergic cerebral vasodilator effects of ketamine in rabbits. Stroke. 1987;18:445–9.
Oren RE, Rasool NA, Rubinstein EH. Effect of ketamine on cerebral cortical blood flow and metabolism in rabbits. Stroke. 1987;18:441–4.
Pfenninger E, Dick W, Ahnefeld FW. The influence of ketamine on both the normal and raised intracranial pressure of artificially ventilated animals. Eur J Anaesthesiol. 1985;2:297–307.
Pfenninger E, Grunert A, Bowdler I, Kilian J. The effect of ketamine on intracranial pressure during haemorrhagic shock under the conditions of both spontaneous breathing and controlled ventilation. Acta Neurochir. 1985;78:113–8.
Albanese J, Arnaud S, REy M, et al. Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain injury patients during propofol sedation. Anesthesiology. 1997;87:1328–34.
Bourgoin A, Albanese J, Wereszczynski N, Charbit M, Vialet R, Martin C. Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil. Crit Care Med. 2003;31:711–7.
Bar-Joseph G, Guilburd Y, Tamir A, Guilburd JN. Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. J Neurosurg Pediatr. 2009;4:40–6.
Mayberg TS, Lam AM, Matta BF, Domino KB, Winn R. Ketamine does not increase cerebral blood flow velocity of intracranial pressure during isoflurane/nitrous oxide anesthesia in patients undergoing craniotomy. Anesth Analg. 1995;81:84–9.
Rosen I, Hagerdal M. Electroencephalographic study of children during ketamine anesthesia. Acta Anaesthesiol Scand. 1976;20:32–9.
Manohar S, Maxwell D, Winters WD. Development of EEG seizure activity during and after chronic ketamine administration in the rat. Neuropharmacology. 1972;11:819–26.
Bourn WM, Yang DJ, Davisson JN. Effect of ketamine enantiomers on sound-induced convulsions in epilepsy prone rats. Pharmacol Res Commun. 1983;15:815–24.
Veliskova J, Velisek L, Mares P, Rokyta R. Ketamine suppresses both bicuculline and picrotoxin induced generalized tonic clonic seizures during ontogenesis. Pharmacol Biochem Behav. 1990;37:667–74.
Sheth RD, Gidal BE. Refractory status epilepticus: response to ketamine. Neurology. 1998;51:1765–6.
Sfez M, Le Mapihan Y, Levron JC, Gaillard JL, Rosemblatt JM, Le Moing JP. Comparison of the pharmacokinetics of etomidate in children and adults. Ann Fr Anesth Reanim. 1990;9:127–31.
Brussel T, Theissen JL, Vigfusson G, et al. Hemodynamic and cardiodynamic effects of propofol and etomidate: negative inotropic properties of propofol. Anesth Analg. 1989;69:35–40.
Lehman KA, Mainka F. Ventilatory CO2-response after alfentanil and sedative premedication (etomidate, diazepam, and droperidol): a comparative study with human volunteers. Acta Anaesthesiol Belg. 1986;37:3–13.
Choi SD, Spaulding BC, Gross JB, Apfelbaum JL. Comparison of the ventilatory effects of etomidate and methohexital. Anesthesiology. 1985;62:442–7.
Giese JL, Stockham RJ, Stanley TH, et al. Etomidate versus thiopental for induction of anesthesia. Anesth Analg. 1985;64:871–6.
Morgan M, Lumley J, Whitwam JG. Respiratory effects of etomidate. Br J Anaesth. 1977;49:233–6.
Renou AM, Vernhiet J, Macrez P, et al. Cerebral blood flow and metabolism during etomidate anaesthesia in man. Br J Anaesth. 1978;50:1047–51; Moss E, Powell D, Gibson RM, McDowall DG. Effect of etomidate on intracranial pressure and cerebral perfusion pressure. Br J Anaesth. 1979;51:347–52.
Modica PA, Tempellhoff R. Intracranial pressure during induction of anesthesia and tracheal intubation with etomidate-induced EEG burst suppression. Can J Anaesth. 1992;39:236–41.
Gancher S, Laxer KD, Krieger W. Activation of epileptogenic activity by etomidate. Anesthesiology. 1984;61:616–8.
Ebrahim ZY, DeBoer GE, Luders H, Hahn JF, Lesser RP. Effect of etomidate on the electroencephalogram of patients with epilepsy. Anesth Analg. 1986;65:1004–6.
Ghoneim MM, Yamada T. Etomidate: a clinical and electroencephalographic comparison with thiopental. Anesth Analg. 1977;56:479–85.
Doenicke AW, Roizen MF, Kugler J, Kroll H, Foss J, Ostwald P. Reducing myoclonus after etomidate. Anesthesiology. 1999;90:113–9.
Patel A, Dallas SH. A trial of etomidate infusion anaesthesia for computerized axial tomography (letter). Anaesthesia. 1981;36:63.
Kay B. A clinical assessment of the use of etomidate in children. Br J Anaesth. 1976;48:207–10.
Schechter WS, Kim C, Martinez M, Gleason BF, Lund DP, Burrows FA. Anaesthetic induction in a child with end-stage cardiomyopathy. Can J Anaesth. 1995;42:404–8.
Tobias JD. Etomidate: applications in pediatric anesthesia and critical care. J Intensive Care Med. 1997;12:324–6.
Ching KY, Baum CR. Newer agents for rapid sequence intubation: etomidate and rocuronium. Pediatr Emerg Care. 2009;25:200–7.
Wagner RL, White PF, Kan PB, et al. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med. 1984;310:1415–8.
Annane D. ICU physicians should abandon the use of etomidate. Intensive Care Med. 2005;31:325–6.
Cotton BA, Guillamondegui OD, Fleming SB, et al. Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients. Arch Surg. 2008;143:62–7.
Markowitz BP. The drug that would not die (though patients receiving it do)(editorial). Pediatr Crit Care Med. 2009;10:418–9.
Duthie DJR, Fraser R, Nimmo WS. Effect of induction of anaesthesia with etomidate on corticosteroid synthesis in man. Br J Anaesth. 1985;57:156–9.
Donmez A, Kaya H, Haberal A, Kutsal A, Arslan G. The effect of etomidate induction on plasma cortisol levels in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 1998;12:182–5.
Absalom A, Pledger D, Kong A. Adrenocortical function in critically ill patients 24 hour after a single dose of etomidate. Anaesthesia. 1999;54:861–7.
Vinclair M, Broux C, Faure P, et al. Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. Intensive Care Med. 2008;34:714–9.
Ray DC, McKeown DW. Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock. Crit Care. 2007;11:145–7.
Sprung CL, Annane D, Keh D, et al. CORTICUS study group: hydrocortisone therapy for patients with septic shock. JAMA. 2002;288:862–71.
Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37:666–88.
Tobias JD. Airway management in the pediatric trauma patient. J Intensive Care Med. 1998;13:1–14.
Selander D, Curelaru I, Stefansson T. Local discomfort and thrombophlebitis following intravenous injection of diazepam. A comparison between a glycerol-water solution and a lipid emulsion. Acta Anaesthesiol Scand. 1981;25:516–8.
Forrest P, Galletly DC. A double-blind comparative study of three formulations of diazepam in volunteers. Anesth Intensive Care. 1988;16:158–63.
Reves JG, Fragan RJ, Vinik R, et al. Midazolam: pharmacology and uses. Anesthesiology. 1985;62:310–7.
Lloyd-Thomas AR, Booker PD. Infusion of midazolam in paediatric patients after cardiac surgery. Br J Anaesth. 1986;58:1109–15.
Silvasi DL, Rosen DA, Rosen KR. Continuous intravenous midazolam infusion for sedation in the pediatric intensive care unit. Anesth Analg. 1988;67:286–8.
Rosen DA, Rosen KR. Midazolam for sedation in the paediatric intensive care unit. Intensive Care Med. 1991;17:S15–9.
Jacqz-Algrain E, Daoud P, Burtin P, Desplanques L, Beaufils F. Placebo-controlled trial of midazolam sedation in mechanically ventilated newborn babies. Lancet. 1994;344:646–50.
Beebe DS, Belani KG, Chang P, et al. Effectiveness of preoperative sedation with rectal midazolam, ketamine, or their combination in young children. Anesth Analg. 1992;75:880–4.
McMillian CO, Spahr-Schopfer IA, Sikich N, et al. Premedication of children with oral midazolam. Can J Anaesth. 1992;39:545–50.
Karl HW, Rosenberger JL, Larach MG, Ruffle JM. Transmucosal administration of midazolam for premedication of pediatric patients: comparison of the nasal and sublingual routes. Anesthesiology. 1993;78:885–91.
Theroux MC, West DW, Cordry DH, et al. Efficacy of midazolam in facilitating suturing of lacerations in preschool children in the emergency department. Pediatrics. 1993;91:624–7.
Tobias JD. Subcutaneous administration of fentanyl and midazolam to prevent withdrawal following prolonged sedation in children. Crit Care Med. 1999;27:2262–5.
Cote CJ, Cohen IT, Suresh S, et al. A comparison of three doses of a commercially prepared oral midazolam syrup in children. Anesth Analg. 2002;94:37–43.
Bauer TM, Ritz R, Haberthur C, et al. Prolonged sedation due to accumulation of conjugated metabolites of midazolam. Lancet. 1995;346:145–7.
Trouvin JH, Farinotti R, Haberer JP, et al. Pharmacokinetics of midazolam in anesthetized cirrhotic patients. Br J Anaesth. 1988;60:762–7.
Vinik HR, Reves JG, Greenblatt DJ, et al. The pharmacokinetics of midazolam in chronic renal failure patients. Anesthesiology. 1983;59:390–4.
de Wildt SN, de Hoog M, Vinks AA, et al. Population pharmacokinetics and metabolism of midazolam in pediatric intensive care unit patients. Crit Care Med. 2003;31:1952–8.
Payne K, Mattheyse FJ, Liebenberg D, et al. The pharmacokinetics of midazolam in paediatric patients. Eur J Clin Pharmacol. 1989;37:267–72.
Shapiro BA, Warren J, Egol AB, et al. Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Crit Care Med. 1995;23:1596–600.
Pohlman AS, Simpson KP, Hall JCB. Continuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support: a prospective, randomized study. Crit Care Med. 1994;22:1241–7.
Dundee JW, Johnston HM, Gray RC. Lorazepam as a sedative-amnestic in an intensive care unit. Curr Med Res Opin. 1976;4:290–5.
Lugo RA, Chester EA, Cash J, et al. A cost analysis of enterally administered lorazepam in the pediatric intensive care unit. Crit Care Med. 1999;27:417–21.
Tobias JD, Deshpande JK, Gregory DF. Outpatient therapy of iatrogenic drug dependency following prolonged sedation in the Pediatric Intensive Care Unit. Intensive Care Med. 1994;20:504–7.
Arbour R, Esparis B. Osmolar gap acidosis in a 60 year old man treated for hypoxemic respiratory failure. Chest. 2000;118:545–6.
Reynolds HN, Teiken P, Regan M, et al. Hyperlactatemia, increased osmolar gap, renal dysfunction during continuous lorazepam infusion. Crit Care Med. 2000;28:1631–4.
Arroliga AC, Shehab N, McCarthy K, Gonzales JP. Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults. Crit Care Med. 2004;32:1709–14.
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Martin, D.P., Tobias, J.D. (2014). Pharmacology of Inhalational and Intravenous Anesthetic Agents. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6359-6_2
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