Intravenous general anesthetics

Intravenous general anesthetics

Drug monograph · NCLEX study reference
Therapeutic class	Anesthetic, sedative
Pharmacologic class	IV anesthetics and sedatives
Onset / peak / duration	Propofol and etomidate seconds to induce; short duration; dexmedetomidine infusion for ICU sedation.
Half-life / level	Short distribution; no routine level.
Routes	IV
High-alert (ISMP)	Yes (propofol)
Black box warning	None
Antidote / reversal	Supportive care and airway management.
Pregnancy / lactation	Used in monitored anesthesia care as needed.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Intravenous general anesthetics — Anesthetic, sedative; IV anesthetics and sedatives.

Identification

• Therapeutic class: Anesthetic, sedative.
• Pharmacologic class: IV anesthetics and sedatives.

Pharmacology

• Mechanism of action: Produce rapid sedation and anesthesia by enhancing GABA (propofol, etomidate), NMDA antagonism (ketamine), or alpha-2 agonism (dexmedetomidine, which sedates without respiratory depression).
• Onset / peak / duration: Propofol and etomidate seconds to induce; short duration; dexmedetomidine infusion for ICU sedation.
• Half-life / therapeutic level: Short distribution; no routine level.

Clinical use

• Indications: Anesthesia induction and maintenance, procedural sedation, ICU sedation (propofol, dexmedetomidine), rapid sequence intubation (etomidate, ketamine), analgosedation (ketamine).
• Usual dose, route, frequency: IV bolus or infusion in monitored settings only.
• Maximum dose / adjustments: Titrate to effect; avoid prolonged high-dose propofol (infusion syndrome); ketamine controlled (C-III).

Safety

• Contraindications: Propofol with egg or soy allergy (caution); ketamine in severe uncontrolled hypertension; etomidate caution with adrenal suppression.
• Black box warning: None.
• Interactions: Other CNS depressants and opioids (deeper sedation and respiratory depression), antihypertensives.
• Pregnancy / lactation: Used in monitored anesthesia care as needed.
• High-alert: Yes (propofol).

Adverse effects

• Common side effects: Hypotension and apnea (propofol, etomidate), emergence reactions and hypertension (ketamine), bradycardia and hypotension (dexmedetomidine), injection-site pain (propofol).
• Serious effects to report: Propofol infusion syndrome (metabolic acidosis, rhabdomyolysis, cardiac failure), severe hypotension, apnea, laryngospasm.
• Antidote / reversal: Supportive care and airway management.

Nursing process

• Assessment before administration: Airway, hemodynamics, allergies, monitoring equipment readiness.
• Interventions during therapy: Use only with airway and resuscitation support; propofol vials discarded within 12 hours (supports microbial growth); strict aseptic technique; continuous monitoring.
• Monitor: Respiratory status, blood pressure, heart rate, sedation depth, triglycerides with prolonged propofol.
• Evaluation / expected outcome: Appropriate sedation or anesthesia with airway control.

Patient teaching

• Patient teaching: Procedural; advise about possible dreams or confusion on waking (ketamine).
• Notify provider if: Not applicable (monitored setting); team manages adverse effects.
• Administration tips: Monitored anesthesia or ICU only; aseptic handling of propofol.