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For decreasing secretions, what is the duration of action for Atropine?

4 hours

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?

0.4-1mg IV

Atropine dose for symptomatic Bradycardia?

0.5-1mg IV

Any significant contraindications for Atropine?

No

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

0.1-0.2mg IV

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

2-10mg IV

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

1-2.5mg/kg

IV maintenance infusion of Ketamine

Low: 30mcg/kg/min, Med: 60mcg/kg/min, High: 100mcg/kg/min

IV maintenance Bolus

0.5-1.0 mg/kg

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

6 hours

Induction dose for Propofol

2-2.5mg/kg IV

Maintenance dose for Propofol

0.1-0.2mg/kg/min

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)

Morphine dose

2.5-10mg IV

CI for morphine

None

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

2-10mcg/kg IV

CI for Fentanyl

None

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

Ephedrine Dose

5-20mg IV

Effects of Ephepdrine

Hypertension, tachycardia, anxiety, tremors

Dose for Naloxone

0.1-1mg IV

Dose for Flumazennil

0.2mg increments Max dose 3-5mg

Dose of Ondansetron

4mg IV over 1-5 min

Dose of Promethazine

12.5-25mg IV

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