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Induction drugs are the
drugs that we give
intravenously to help people go to sleep. And, the bottom line
with induction drugs is, they have to be rapid
onset and pleasant. And they should
wear off fairly quickly, so that the patients
can be turned over to vapours as soon
as possible. Thiopentone is the classic
induction drug and it's been used
since Pearl Harbor basically,
December 7, 1941 when it was widely
used after the attack on Pearl Harbor
and perhaps hypothetically,
it's often stated that more US
soldiers died from Pentothal, than they did
from Japanese bullets. I think that's probably
unlikely, but it was the first time it was widely used,
and it was a very potent drug, and potentially very dangerous,
and they didn't know how to use it. Propofol,
which is the cardiologist drug of choice if you think
of Michael Jackson or Joan Rivers
from the ENT surgeon, this is a drug
that has become extremely popular, but can be horribly
mismanaged by people who don't understand
how to use it. It's the commonest modern
induction drug. It has a very rapid onset, although
not quite as fast as Pentothal, but a more
rapid recovery then Pentothal, and
much less hangover than Pentothal. It also
has some antiemetic effect, so it produces
little nausea and vomiting, and in fact, we can
actually give it as a antiemetic during the surgery.
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It does however produce myocardial
depression, as does Pentothal.
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Unfortunately, Propofol also produces
decreased vascular resistance, cause
dilatation of peripheral blood vessels,
so profound hypotension is not uncommon
during induction with this drug.
It's not suitable
for unstable patients. It is however
useful as an intravenous sedative
or it can be used as the primary anesthetic without a vapour.
This is known as total intravenous anesthesia,
or TIVA. Ketamine, we've mentioned
briefly previously, it can also be used as
an induction drug. It actually is an effective analgesic,
which none of the other induction drugs are,
but it does produce that Emergence Phenomena
I mentioned to you. It supports cardiovascular
function by increasing heart rate and blood
pressure moderately. It's often used in unstable
patients and the Emergence Phenomena
can be reduced by adding a benzodiazepine,
such as Lorazepam or Midazolam
late in the case. Etomidate
is also an induction drug, and it's been used
in the US since 1975, but
in my country, Canada, it's only been used
since 2005, because of the very small market
for it, in Canada. It supports cardiovascular
systems in trauma patients,
but causes adrenal suppression. And some recent
studies have suggested that there's an increase
death rate in patients who receive Etomidate,
with no evidence during the surgery
itself that it's causing any risk. But it may
be useful in patients with brain trauma
because it does maintain cerebral oxygenation
and cerebral blood flow, at the time of induction.