Abstract
Optimal patient care often calls for the use of adjuvant medications, which may include sympathomimetic drugs, antiemetics, and non-opioid analgesic agents such as ketorolac and dexmedetomidine.
Sympathomimetics are used to support the cardiovascular system and blood pressure by increasing peripheral vascular resistance, heart rate, and/or cardiac contractility. Phenylephrine is an alpha agonist used to increase peripheral vascular resistance. Ephedrine, norepinephrine, and epinephrine are mixed alpha/beta agonists, with differing ratios of alpha and beta activity. Dopamine acts at alpha, beta, and dopamine receptors, with the ratio of activity varying with the dose administered.
Prevention and treatment of post-operative nausea and vomiting is a major goal of anesthetic management and can be accomplished by modulating a variety of neurotransmitter systems. Classes of medications include serotonin antagonists (ondansetron), antihistamines (promethazine), steroids (dexamethasone), dopamine antagonists (droperidol or haloperidol), anticholinergics (scopolamine), and neurokinin-1 antagonists (aprepitant).
In addition to opioids and ketamine, which were discussed in previous chapters, ketorolac and dexmedetomidine can be useful anesthetic and analgesic adjuvants. Ketorolac is a non-selective COX inhibitor and dexmedetomidine is a selective α2 agonist.
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Wolfe, J.W., Ehrenfeld, J.M. (2022). Pharmacology of Adjunct Agents. In: Ehrenfeld, J.M., Urman, R.D., Segal, B.S. (eds) Anesthesia Student Survival Guide. Springer, Cham. https://doi.org/10.1007/978-3-030-98675-9_7
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