Anesthesia Drug Reference
Benzodiazepines
Midazolam
2ml (1mg/ml) Typical dose: 1-2mg Induction: 0.2-0.4mg/kg Gtt: 0.05-0.4mg/kg/hr Onset: 3-5min; Duration: <2hrs Elimination: Urine
Scopolamine
1.5mg patch 0.2-0.4mg IV (5mcg/kg) for amnesia in trauma if hemodynamically unstable
Flumazenil
Dose: to antagonize disinhibitory reaction to benzos- 0.01 mg/kg Onset: 1-2min, peak 6-10min; Duration: 1hr Elimination: Hepatobiliary, Urine
Diazepam
5mg IM 2.5mg IV
Opioids
lean body weight
Alfentanil
5ml, 500 mcg/ml Induction dose 20-30 mcg/kg Infusion 0.5 mcg/kg/min, could go up to 1 mcg or even higher Bolus: 150-250mcg Dilute to 100mcg/ml Take the 5cc vial which is 500mcg/cc and put all of in into 20cc saline so you have 2500mcg in 25cc or 100mcg/cc 1/10th vs 1/4th as potent as fentanyl, fastest onset time of all opioids Onset: 1-2min; Peak: 90 seconds; Duration: 30-60min vs 10-20min? Elimination: Urine
Fentanyl
5ml (50mcg/ml) Induction: 1-3mcg/kg (5mcg/kg for Neuro); LBW Typical dose: 50-150mcg Bolus: 25-50mcg Onset: 1-2min; Peak 3-5min; Duration: 30min-60min 50% effect: 10-20min Elimination: Hepatobiliary, Urine IM: 7-15min onset, 1-2hr duration Intranasal: 7-8min onset, 1-2hr duration
Hydromorphone
1mg/ml Typical dose: 0.4mg Onset: 5-15min; Peak: 10-20min; Duration: 2-4hrs Elimination: Urine
Meperidine
25mg/ml Dilute to 5mg/ml Typical dose: 25-50mg Onset: 5-15min; Peak: 8min?; Duration: 2-4hrs 50% effect: 1hr
Methadone
0.1-0.3mg/kg (max 20mg) Peak: 5-15 minutes; Duration: 6-8hrs; 24hrs? 50% effect: 1 hour
Morphine
Typical Dose: 4-8mg IV Onset: 5-10min; Peak: 30-90min; Duration: 3-5hrs Elimination: Hepatobiliary, Urine
Naloxone
RR <6 or somnolence/sedation- 0.04 MG IV, may repeat x1 Apnea or unarousable- 0.2 – 0.4 MG IV, may repeat x1 Onset: 2min; Duration: 30min-2hrs Elimination: Urine
Remifentanil
2mg into 40 ml = 50 mcg/ml OR 1mg into 20ml Dilute to 50mcg/ml Induction: 3-5mcg/kg/min (1-2min prior to intubation); LBW Infusion: 0.05-0.2 mcg/kg/min Bolus: 1mcg/kg; Pinning: 2-4mcg/kg (50-250mcg) Onset: 3-5min; Peak: 90 seconds?; Duration: 5-10min
Sufentanil
Use 50 mcg/ml, 5 ml vial Dilution: For 250mcg/5ml vial, dilute 250mcg into 50cc for 250/50 = 5mcg/cc Take out 10cc for bolusing 5mcg at a time Or can 2mL in 10mL vial = 10mcg/mL; The rest of 150 mcg dilute into 30 ml to make 5 mcg/ml Induction: 0.1-0.3 mcg/kg Typical dose 10-15mcg 10 mcg approximately equals 100 mcg fentanyl Bolus: 5mcg Maintenance: 0.1-0.5 mcg/kg/hr. Decrease by 1/2 to 1/3 over each 1/3 of case (.3/.2/.1). Turn off 15-45 minutes prior to closing. Onset: 1-3min vs 3-5min; Duration: 5min vs 20-45min Elimination: Urine
Induction Agents
Dexmedetomidine
2ml (100mcg/ml) Induction: 0.5-1 mcg/kg (usually 1 mcg/kg) over 10-20 minutes Maintenance: 0.2-1.2mcg/kg/hr Bolus: 1 mcg/kg is standard but can cause bradycardia. Can dilute to 10 mcg/cc and start with 10 mcg boluses or 0.5 mcg/kg Dilution: If 100 mcg/ml vial: Dilute 2cc in 50cc NS to make 4 mcg/ml solution Onset: 5-10min; Peak 15-30; Duration: 1-2hrs Elimination: Urine
Etomidate
10-20ml (2mg/ml) Typical dose: 0.2-0.3mg/kg (10-20mg); LBW Onset: 30-60sec, peak 1min; Duration: 3-5min Elimination: Urine
Methohexital
0.75-1 mg/kg
Pentobarbital
10 mg/kg over 30 minutes, 5 mg/kg/hr for 3 hours, then 1 mg/kg/hr
Propofol
20ml (10mg/ml) Typical dose: 1-2mg/kg IBW or LBW (150mg) MAC: 25-75mcg/kg/min TIVA: 100-150mcg/kg/min; TBW Onset: 30 seconds; Duration: 3-10min Elimination: Urine
Thiopental
Induction: 3-5mg/kg; LBW, TBW Maintenance
Neuromuscular Blockers
ideal body weight
Succinylcholine
10ml (20mg/ml) Typical dose: 1-2mg/kg (100mg); TBW; Laryngospasm- 0.5mg/kg Onset: 30 seconds- 1min; Duration: (3-5min) 5-10min Elimination: Urine
Rocuronium
5-10ml (10mg/ml) Typical dose: 0.6mg/kg (40mg); ideal body weight RSI dose: 1.2mg/kg Defasciculating dose: 0.03mg/kg (2mg) Onset: 1-2min; Duration: 20-35min Metabolism: None Elimination: Hepatic 70%, Renal 30%
Pancuronium
Metabolism: Hepatic 10-20% Elimination: Hepatic 15%, Renal 85%
Vecuronium
Mix to 1mg/ml Typical dose: 0.1-0.2mg/kg (7mg); IBW Onset: 3-5min; Duration: 20-35min Metabolism: Hepatic 30-40% Elimination: Hepatic 50-60%, Renal 40-50%
Cisatracurium
10ml (2mg/ml) Typical dose: 0.1-0.2mg/kg Onset: 2-3min; Duration: 30-60 minutes Half-life: 22-25 minute Metabolism: Hoffman 80% Elimination: Renal 20%
Reversal
Suggammadex
2 or 5ml (100mg/ml) Typical dose (with twitches): 2-4mg/kg (140-200mg); 16mg/kg after RSI dose
Neostigmine
10ml (0.5mg/ml) but varies Typical dose: 0.02-0.05mg/kg (3-5mg); max dose 0.07mg/kg or 5mg (whichever is less) If recovery already complete, can probably use 0.015-0.02mg/kg Onset: 10-30min; Duration: 2-4hrs Elimination: Urine
Glycopyrrolate
5ml (0.2mg/ml) Typical dose: 0.008-0.01mg/kg (0.6-1mg) *0.2mg (1mL) for each 1mg Neostigmine **0.5-2mg for Vagolytic effect; does not cross BBB Peds: 0.005mg/kg IV or 0.01mg/kg IM 15 minutes for full effect Onset: 1min; Duration: peak 3hrs Elimination: Urine and Hepatobiliary
Atropine
1ml (0.4mg/ml) Typical dose: 0.5mg Peds: 0.01 mg/kg IV or 0.02 mg/kg IM Onset: 1-4min; Duration: <4hrs Elimination: Urine
Analgesics
Acetaminophen
1000mg IV or PO Peds: 75 mg/kg PO/IV at ideal body weight in a 24 hour period
Ketamine
Loading dose 0.5 mg/kg before incision Induction 1-2mg/kg IV; 4-8mg/kg IM (Usually ~2mg/kg IM is sufficient, can add ~0.4mcg/kg Glycopyrrolate for secretions) Sub-dissociative dose: 0.15-0.25 mg/kg/hr; (<30mg/hr; titrate q2-3hr) Maintenance (Analgesia): 0.25mg/kg/hr or: 2-5mcg/kg/min Onset: 30 sec (Oral 10-30min), Duration: 5-10min; (Oral: 40-50min), Recovery in 1-2hrs Metabolism: Hepatic Elimination: Urine
Lidocaine
1-1.5mg/kg (LBW/ABW) bolus, followed by 1-2mg/kg/hr Considerations: Narrow therapeutic window; CNS toxicity symptoms begin with tongue numbness, metallic taste, lightheadedness, tinnitus, progress to visual disturbances, twitching, unconsciousness, and seizures. CV toxicity at higher plasma level - arrhythmias, hypertension > hypotension, conduction abnormalities
Magnesium
Infusion 6mg/kg/hr with 30mg/kg loading dose over 30-60 minutes. Considerations: Potentiates neuromuscular blockade, can prolong emergence, can cause hypotension, bradycardia, prolonged PR or QT interval, burning/heat sensation in awake patient
Pressors/Inotropes
Angiotensin II
20 ng/kg/min
Dopamine
400 mg in 250 ml = 1600 mcg/ml Infusion: 2-20 mcg/kg/min
Dobutamine
500mg in 250ml = 2000mcg/ml (2mg/ml) Infuse at 2-20 mcg/kg/min
Ephedrine
Mix to 5mg/ml Typical dose: 5-10mg; 0.5-0.6mg/kg IM Dilute 50mg in 10cc NS = 5mg/ml Onset: 5-15min Duration: 15-30min Elimination: Urine
Epinephrine
4 mg in 250 ml = 16 mcg/ml OR 1 mg in 250 ml = 4 mcg/ml Mix to 10mcg/ml Infusion: 0.02-0.3 mcg/kg/min OR 2-30mcg/min Typical dose: 5-10mcg (1mcg/kg, 10mcg/kg in code); 100-500mcg IM 1 mcg/kg, max dose is code dose of 0.01 mg /kg Dilute 1mg into 100cc bag = 10mcg/cc Onset: Immediate IV, 5-10min subQ Duration: 5min half-life Elimination: Urine
Isoproterenol
1mg in 250ml = 4mcg/ml 1-5mcg/min
Milrinone
20 mg in 100 ml = 200 mcg/ml Load 20-75 mcg/kg over 10 min Infuse: 0.125 -0.75 mcg/kg/min
Norepinephrine
4 mg in 250 ml = 16 mcg/ml Infusion: 0.02 - 0.3 mcg/kg/min = 20-300 nanograms/kg/min = 2-20mcg/min Bolus: 4-8mcg Dilute to 4 or 8mcg/ml Take 5ml of dilute Norepi (16mcg/ml) and add to 5cc saline = 8mcg/ml Onset: 1-2min Elimination: Urine
Phenylepherine
Mix to 100mcg/ml 10 mg in 100 ml = 100 mcg/ml 40 mg in 250 ml = 160 mcg/ml 50 mg in 250 ml = 200 mcg/ml Infusion: 0.2-2mcg/kg/min Typical dose: 50-100mcg; 2-5mg IM Can also do 10 mg in 250 ml = 40 mcg/ml. 1 cc/minute, which would be 40 mcg/minute. Onset: IV- immediate, IM-10-15min Duration: 10-20min Elimination: Urine
Vasopressin
100 units in 100 ml = 1 unit/ml OR 60 units in 100ml = 0.6unit/ml Push dose: 0.5-1unit Infusion: 0.01-0.04 units/min (no weight calc) Dilute one 20u vial into 20ml = 1u/ml
Antihypertensives
Esmolol
2500 mg in 250 ml = 10 mg/ml Infusion: 50-300 mcg/kg/min Can load with 0.5 mg/kg over 1 minute Bolus: 0.2-0.5 mg/kg: use around 40-60 mg for induction if heart rate is around 70-80 (Usually 20-40mg intraop) Onset: 2-10min, Duration: 10-20min, Elimination: Urine RBC Esterase Metabolism
Clevidipine
25mg in 50ml = 0.5 mg/ml OR 50mg in 100ml = 0.5mg/ml Infusion: 1-20 mg/hr Dose may be doubled every 90 sec Bolus: 0.05-0.1mg 0.1cc = 0.05mg Can dilute to 0.05mg/ml (1cc in 9cc saline) Onset: 2-4 minutes Duration: half life 15 minutes
Diltiazem
100 mg/100 ml = 1 mg/ml Load 2.5 mg up to 25 mg Then infuse 2-10 mg/hr (no weight calc)
Hydralazine
Onset: 10-80min Duration: Up to 12hrs Elimination: Urine
Labetalol
Intra-op rescue: start with 5-10mg IV; 0.2mg/kg, double dose q10min, max 300mg Onset: 5min, peak 5-15min Duration: 2-4hrs (16-18hrs) Hepatic Metabolism α:β 1:7 IV, 1:3 PO
Mannitol
250ml 20% 0.25-1g/kg Metoprolol Intra-op rescue: start with 2.5-5mg IV
Nesiritide (BNP)
1.5mg in 250ml = 6mcg/ml Load 2mcg/kg over 1min, then infuse 0.1mcg/kg/min
Nicardipine
25 mg in 250 ml = 0.1 mg/ml Infusion: 1-15 mg/hr (no weight calc); Vasospasm: 0.075 – 0.15 mg/kg/hr Bolus: 50-100mcg (up to 500mcg) Onset: 2min, Duration: 60min Liver metabolism; Increases contractility; Increased HR in 25%
Nitroglycerin
50mg/100ml = 500mcg/ml OR 50 mg/250 ml = 200mcg/ml Infusion: 5-10mcg/min up to 200mcg/min; (0.1-3mcg/kg/min) Bolus: 50-100mcg; (1.5-2.5mcg/kg prior to laryngoscopy) Dilute 5ml of 200mcg/ml in 20cc = 50mcg/ml or 200mcg in 10cc = 20mcg/ml *binds to PVC tubing- use PET tubing
Nitroprusside
50mg/100ml = 500mcg/ml OR 50 mg in 250 ml = 200 mcg/ml Can further dilute to 25-50mcg/ml (10-20cc) or 5mcg/ml (100cc) Infusion: 0.1-1 mcg/kg/min Bolus: 10-20mcg; MAP decreases ~20mmHg/15mcg
Phentolamine
For tissue extravasation 5-10 mg w/in 12 hours of extravasation Dilute to 0.5 mg/mL then inject in multiple locations, in 1 mL increments
Antiarrhythmics
Adenosine
0.3-0.6 (0.5-1) mg/kg provides flow arrest of 12-50 seconds; 12mg if hypothermic (normal ACLS dose)
Amiodarone
1200 mg in 250 ml = 4.8 mg/ml Load 150-300 mg then infuse 1 mg/ml (no weight calc)
Diltiazem
100mg in 100ml = 1000mcg/ml (1mg/ml) Load 2.5mg up to 25mg, then infuse 2-10mg/hr
Lidocaine
2 g in 250 ml = 8 mg/ml Load 50-100 mg then infuse 1-2 mg/min ( no weight calc) or start at 1 mg/kg/hr; check plasma levels Q8H
PONV
Dexamethasone
4-8mg IV at start of case Onset:
Ondansetron
4-8mg Onset: 30 min Elimination: Urine
Prochlorperazine
10mg IV
Promethazine
25mg IM
Anticoagulation:
Protamine
1mg neutralizes 100u heparin (ie. 22ml Protamine for 22ml Heparin)
Dyes
Fluorescein (Orange)
0.2-1cc at a time (20-100mg) Comes as 500mg/5ml, (100mg/mL) in 5 mL vial
Indocyanine Green (ICG)
25mg/vial, dilute in 10cc (label says 5cc) to 2.5mg/ml Give 1-3cc bolus at a time Max dose is 2mg/kg Use w caution in pts w contrast allergy (contains 5% sodium iodide)
Inhaled Medications:
iNO (inhaled nitric oxide)
1-80 parts per million (ppm)
Epoprostenol (Valetri)
1-2 ng/kg/min up to 80 ng/kg/min