For decreasing secretions, what is the duration of action for Atropine?
Why is atropine given preoperatively
Diminishing secretions and blocking cardiac vagal reflexes
Effects of Atropine?
Tachycardia, flushing of skin, decreased sweating
Atropine dose for decreasing secretions?
Atropine dose for symptomatic Bradycardia?
Any significant contraindications for Atropine?
What are two distinct advantage of Gylcopyrrolate over Atropine?
More potent in decreasing secretions (duration of action is 7 hours), causes less Tachycardia
Effects of Glycopyrrolate
Flushed skin, Tachycardia, Decreased sweating
Dose for Glycopyrrolate
Reason for use of Diazepam
Initial dedation, muscle relaxation, amnesia, relief of anxiety
The secondary metabolite caused by Diazepam is responsible for what?
Contributes to sedation and causes it to have a long duration
Effects of Diazepam
Loss of airway control, respiratory depression, hypotension. Synergistic effect with opiods
Dose for Diazepam
CI for diazepam
Untreated open/narrow angle glaucoma. Also IM route not recommended
Reason to use Midazolam
Same as Diazepam
Why is Midazolam a better choice than Diazepam
Greater amnesia than Diazepam, no secondary metabolite, can be used on children
Effects of Midazolam
Respiratory depression, loss of airway, synergistic effects with opiods
Dose of Midazolam
1mg IV q 2-3 min. Titrate to effect
CI for Midazolam
Acute narrow angle glaucoma, COPD pts.
What are the two induction medications used
Ketamine and Propofol
Is Ketamine a sedative?
No, it is primarily an analgesic with some sedative properties
What receptors does Ketamine affect
NMDA receptors. Close these receptors, blocking signals from passing to the brain and spinal cord (very difficult to titrate for this "open or closed" action)
Effects of Ketamine
Hallucinations, Inc. HR and BP (inc production of endogenous catecholamines) Inc. Salivation (fear of laryngospasm is rational for use of anti-cholinergic)
Does Ketamine cause muscle relaxation?
No, pt. may move extremities, or vocalize (reason for use of benzos or propofol)
IV induction dose of Ketamine
IV maintenance infusion of Ketamine
Low: 30mcg/kg/min, Med: 60mcg/kg/min, High: 100mcg/kg/min
IV maintenance Bolus
CI for Ketamine
Hypertension, Cardiovascular disease, Head inj, pregnancy
What are some advantages of Propofol
Rapid induction, Rapid return to consciousness, minimal residual effects opn CNS, decreased N/V
Does Propofol have analgesic properties
No, must be used with analgesia adjunct (opiates, ketamine, regional)
Effects of Propofol
Hypotension, Ventilation depression/apnea, painful administration.
How quickly do you have to use Propofol after opening
Induction dose for Propofol
Maintenance dose for Propofol
Intermittent IV bolus dose of Propofol
20-50mg IV slow push
CI for Propofol
Hemorrhaging pts., poor cardio function, head injuries w/ ICP, allergies to soy or egg, Pts w/ reactive airway disease (asthma)
CI for morphine
Advantage of Fentanyl over Morphine
75-100x stronger, rapid onset and short duration
Effects of Fentanyl
Sedation, Euphoria, Respiratory depression, N/V, constipation, muscle rigidity if administered too quickly
Dose for Fentanyl
CI for Fentanyl
Dose for Nalbuphine
5-10mg q 3-6 hours
What is the most common cause of cardiac arrest during anesthesia
Hypoxia and Hypercardia due to insufficient oxygenation and ventilation
TX for cardiac arrest during anesthesia
Identify problem, stop anesthetic drugs/end procedure, ACLS
TX for anaphylaxis
Epi (1:1000) 0.3-0.5 SC or IM Epi (1:10,000) reserved for resistant life threatening cases. Albuterol 2.5 nebulized, Benadryl 50-100mg
Effects of Ephepdrine
Hypertension, tachycardia, anxiety, tremors
Dose for Naloxone
Dose for Flumazennil
0.2mg increments Max dose 3-5mg
Dose of Ondansetron
4mg IV over 1-5 min
Dose of Promethazine