Induction for Sim Lab Flashcards
When are we allowed to give premeds?
AFTER the consents are signed!
What is the dose of Versed?
0.5-5 mg IV
What is the concentration of Versed?
1 mg/mL
Total vial= 2 mg/2mL
What is the dose of Fentanyl (combo)?
1-2 mcg/kg IV
Say, “I am going to give 1 mcg/kg and my patient is 100 kg, so 100 mcg of fentanyl.”
What is the concentration of Fentanyl?
50 mcg/mL
Total vial= 100 mcg/ 2mL
or 250 mcg/5 mL
What is the dose of Lidocaine
1-2 mg/kg IV
use higher because helps propofol burn and circumoral numbness
NOT for patient with seizure hx because lowers threshold
What is the concentration of Lidocaine
20 mg/ml
Total vial= 100mg/5mL
What is the dose of Propofol?
1-3 mg/kg average
depends on patient* (small for old/unhealthy, high for neonate- high metabolism)
higher for LMA
What is the concentration of Propofol?
10 mg/mL
Total vial= 200mg/ 20mL
What do you do after giving propofol?
Check for responses to see if sedated: lash, talk (hearing last to go), touch face
-now know okay to ventilate patient
What do you do if ventilating and not moving air?
1) readjust mask
2) turn head
3) place oral airway with tongue blade
What do you do if not moving air after placing an oral airway?
2 hand masking with CRNA
What is the dose of Rocuronium?
Onset, DOA?
0.6 mg/kg for normal induction paralyze cords
1.2 mg/kg for RSI
non-depolarizing neuromuscular blocker
Onset 60-90 seconds
DOA: 20-35 minutes
know you can mask ventilate them before giving Roc
What it the concentration of Rocuronium?
10 mg/mL
Total vial= 50 mg/ 5 mL
What do you do after intubating?
- inflate cuff
- attach circuit
- bag and look for chest rise, mist in tube
- look for EtCO2
- listen
In what order are monitors applied?
1) Pulse ox
2) BP cuff + cycle!
3) EKG leads
then pre-oxygenate!
What is the dose for succinylcholine?
Onset, DOA?
1-2mg/kg
short-acting depolarizing neuromuscular blocking agent
Onset 30-60 seconds
DOA 3-5 min
What it the concentration of succinylcholine?
20 mg/mL
200 mg/ 10 mL
Maintenance dosing for Vecuronium
Intermediate-acting NDNMB If goal= 0/4 twitches and have.. 4 twitches= give 4 mg 3 twitches= give 3 mg 2 twiches= give 2 mg 1 twitch= give 1 mg
What is the concentration of zofran?
4 mg/ 2mL
What is the intubating dose of fentanyl?
5-10 mcg/kg, up to 100 mcg/kg
Prior to intubation of a cardiac pt, what should be noted on ECG?
leads II and V
ST segment
What is special about sufantanil?
5-10x more potent that fentanyl
What is special about remifantanil?
different metabolism by esterases => shortest 1/2 life (DOA 9-20 min)
Synergistic with propofol
What can cause rebound hyperalgesia?
Treatment?
Remifentanil because quick 1/2 life- pt needs addition pain meds for post op.
Rebound hyperalgesia tx with
1) Magnesium sulfate and
2) Ketamine
What is Etomidate/ dosing?
0.2-0.3 mg/kg
GABA-A agonist
Pro/Cons of etomidate?
Pro: hemodynamic stability
Cons: Highest rate of PONV!!
Adrenocortical suppression=> ↓ corticosteroids=> extreme refractory hypotension (esp with pts on chronic steroid)
What is ketamine/dosing?
Causes a _____ anesthesia.
Ketamine= non-competitive NMDA receptor antagonist that causes a DISSOCIATIVE anesthesia.
Induction: 2 mg/kg
Combo: 0.1-0.5 mg/kg (0.5!)
What kinds of patients would you NOT want to use ketamine as the sole induction agent/why?
Not for HTN or CHF because it acts as an indirect sympathomimetic by causing release of catecholamines and ↑ HR/inotropy = ↑ myocardial O2 consumption
↑ ICP pt, because ↑ BP will ↑ ICP
What is precedex/dosing?
Precedex- alpha 2 agonist=> ↓ sympathetic outflow by negative feedback (false NE)
Induction dosing:
1 mcg/kg over 10 minutes loading dose, then 0.2-1.5 mcg/kg/hr
Vecuronium dosing?
intermediate-acting NMBA
0.1 mg/kg
Onset: 3-5 minutes
DOA: 20-35 minutes
What are the MC short, intermediate, and long acting NMBAs?
Short: succinylcholine
Intermediate: Roc, vec, cisatricurium
Long: pancuronium
