Which of the following anesthetic is safe in heart failure -
Ans. is 'a' i.e., Etomidate Etomidateo It has a briefer duration of action 4-8 minutes.o It produces little cardiovascular and respiratory depression-->> Agent of choice for cardiovascular surgeries (bypass, aneurysms, valve surgery). Etomidate is most cardiostable inducing agent.o Coronary perfusion pressure is maintained when it is used with fentanyl.o Similar to thiopentone & propofol, etomidate is cerebroprotective - Decreases cerebral blood flow; metabolism, oxygen consumption and ICT.o Etomidate has the highest incidence of nausea and vomiting amongst inducing agents 30%-40%.o It can produce hiccups and myoclonus .o Superficial thrombophlebitis and pain on injection may occur - Pain can be reduced by using larger vein and injecting lidocaine just before etomidate.o Intraarterial injection is not associated with local or vascular complications.o The specific endocrine effects manifested by etomidate are a dose dependent reversible inhibition of enzyme 11-b-hydroxylase, which coverts I I-deoxycortisol to cortisol and a relative minor effect on 17a - hydroxylase,o There is decreased synthesis of adrenal corticoids with increase in precursors 11-deoxycortisol and 17- hydroxyprogesterone.o ACTH secretion increases due to loss of feed back inhibition,o l it 'CT supplementation restores cortisol levels to normal after use of etomidate.
Etomidate
Propofol
Thiopentone
Ketamine
Cardiopulmonary Resuscitation And Mechanical Ventilation