ANALGESIC/NSAIDS

Question 1

Dexmedetomidine (Precedex)

Answer 1

-Small intraoperative doses: 4 mcg at a time to a max of 0.5 mcg/kg for case
-Infusion: 0.2-0.8 mcg/kg/hr
-Intranasal: 1-2 mcg/kg (usually between 75-100 mcg split between both nares) you’ll put the undiluted amount into a 3 mL syringe and then fill the rest up with NS to total 3 mLs) (won’t see at ARMC but used elsewhere)
o Concentration: 200 mcg/2mL mixed in 50 mL NS bag = 4 mcg/mL solution
o Onset: 5 minute onset; peak in 20-30 minutes
duration: 60-120 min after a bolus.
Precautions: 2nd or 3rd degree heart block, severe ventricular dysfunction, hypovolemia, HoTN, pregnant or breastfeeding, history of renal or liver disease.

Question 2

Ketorolac (Toradol)

Answer 2

-Adult dose: 15-30 mg IV Q6H
-Pediatric dose: 0.5 mg/kg IV Q6H
o Concentration: 30mg/mL
o Onset: 10 minute onset; peak in 2 hours
o ½ Life: 4.5 hours
C/I: Allergy to NSAIDs; active peptic ulcer or bleeding disorder;
o Precautions: Don’t use for more than 5 days; reduce dose to ½ in elderly/renal insufficiency

Question 3

Acetaminophen (Tylenol/Ofirmev)

Answer 3

-IV dose: 1g Q6H over 15 minutes (max 4g); if <50kg 750 mg Q6H
o Onset: 5 minutes IV
o ½ Life: 2-3 hours
C/I: Hypersensitivity to tylenol and severe hepatic failure
o Precautions: lacks anti-inflammatory effects (not true NSAID); does not affect GI or platelets; Reduce dose in severe renal disease and 2g/day for chronic hepatic disease; can increase MI and CVA risk;

Question 4

Gabapentin (Neurontin)

Answer 4

o Dose Range: 300-1200 mg PO
2 hours before OR
sz if abrupt withdrawal

Question 5

Magnesium

Answer 5

-Preop dose: 50 mg/kg IV
-Intraop drip dose: 8 mg/kg/hr IV Q6H (or 2g in first saline bag)
o C/I: In OD, give Calcium
Precautions: Renal patients will need smaller dose

Question 6

· Lidocaine Drip Analgesia

Answer 6

-Bolus dose: 1-2 mg/kg IV over 2-4 minutes
-Intraop drip dose: 1-2 mg/kg/hr IV
o Precautions: Careful monitoring in cardiac, hepatic, renal dysfunction