Intraoperative Meds - ALL NUMBERS [Doses, Concentration, Preparation/Syringe Size, Onset, Duration, T1/2]

Question 1

Propofol

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Answer 1

Dose: 1.5 - 2.5 mg/kg

Standard Concentration: 10 mg/mL

Preparation: 20 mL = 200 mg

Syringe: 20 mL

Drug Class/Use: sedative/hypnotic

Onset: <40 sec

Peak: 1 min

Duration: 5-10 min

T1/2: 11.5 hr (nagelhout)

Question 2

Etomidate:

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Ex: 70 kg pt

Answer 2

• Dose: 0.2 - 0.4 mg/kg
• Standard Concentration: 2 mg/mL
• Preparation: 10 mL = 20 mg
• Syringe: 10 mL
• Drug Class/Use: carboxylated imidazole, induction agent/anesthetic
• Onset: 30-60 seconds
• Peak: 1 minute
• Duration: 3-10 min
• T1/2:

Ex: 70 kg = 14-28 mg /2 mg/mL = 7-14 mL

Question 3

Ketamine:

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

(no preparation info as of yet)

Answer 3

Dose: 1 - 2.5 mg/kg

Standard Concentration: 5 - 100 mg/mL

Preparation:

Drug Class/Use: phenylcyclidine, NMDA antagonist, induction agent, pain adjunct

Onset: 3 - 5 minutes

Peak:

Duration: awakening in 15 minutes, longer for high/repeat doses

T1/2: 2 - 3 hours

Ketamine dart: 4-8 mg/kg IM

IM Peak: 22 minutes

Question 4

droperidol

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Answer 4

• “Just roll on through with that .05-.06”
• -etrons = 5HT3 antagonists, so this one is the DA antagonist
• “So droll with that 2.5 weird as concentration”
• Dose: 0.05-0.06 mg/kg (another source says 15 mcg/kg)
• Standard Concentration: 2.5 mg/mL weeeeird.
• Preparation:
• Syringe:
• Drug Class/Use: DA (D2) antagonist
• Onset: 3-10 minutes
• Peak: 30 minutes
• Duration: 2-4 hrs
• T1/2:
• Other info: DA blockade, but also alpha-adrenergic blockade, so small reductions in BP may occur, esp in volume-depeleted pts. Also prolongs QT interval - 12L EKG required by FDA prior to use

Question 5

dolasetron

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Answer 5

Trade name: Anzemet Dose: 12.5-25 mg/kg, admin within 15 minutes of END of anesthesia Standard Concentration: 12.5 mg/mL Drug Class/Use: 5HT3 antagonist Onset: ~immediate Peak: 36 minutes Duration: 4-9hrs (N926 notes) T1/2: 8.1 hrs

Question 6

metocloperamide

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Answer 6

“You only want 0.25 of your gut to be moving at a time” Dose: 0.1-0.25 mg/kg “Give 10 mg IV slowly over 10 minutes” Standard Concentration: 5mg/mL or 10 mg/mL Drug Class/Use: cholinomimetic, antiemetic, blocks DA receptors in CNS Onset: 1-3 minutes (3-5 minutes N926) SAY 3 MINUTES LOL. Peak: <1 hr Duration: 1-2 hrs T1/2:

Question 7

ondansetron

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Answer 7

Dose: 4 mg IVP, or 0.15 mg/kg Standard Concentration: 2 or 4 mg/mL Drug Class/Use: 5HT3 antagonist, antiemetic Onset: <30 minutes Peak: Duration: 12-24 hours. yea right. T1/2: 3-7 hrs

Question 8

palonosetron

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Answer 8

Dose: 0.75 PONV, 0.25 chemo-induced N/V Standard Concentration: Drug Class/Use: 5HT3 antagonist (100x more affinity for receptor than zofran) Onset: Peak: Duration: T1/2: 40 hours!!!

Question 9

Midazolam

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Answer 9

• Dose: 0.02-0.04 mg/kg
• Standard Concentration: 1 mg/mL
• Preparation: 2 mg = 2 mL
• Syringe: 3 mL
• Drug Class/Use: Benzodiazepine
• Onset: (onset 30-60 seconds) 5 minutes IV, 30 minutes PO (0.4-0.8 mg/kg)
• Peak: 5 minutes
• Duration:
• T1/2: 1.9 hr
• Considerations: decrease in BP/HR if dose >0.2 mg/kg, does not blunt SNS response/ICP increase to laryngoscopy, dose dependent decrease in ventilation → decreased hypoxic drive, CYP 450 - liver metab (dose not altered by renal impairment).
• Can be used for “paradoxical vocal cord movement” - 0.5-1.0 mg

Question 10

Fentanyl

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

Answer 10

• Dose: 1-3 mcg/kg
• Standard Concentration: 50 mcg/mL
• Syringe: 3 or 5 mL
• Preparation: 1 mL = 50 mcg
• Drug Class/Use: phenylpiperidine (truncal rigidity, reflex coughing?)
• Onset: 1-3 minutes
• Peak:
• Duration: “short” (highly lipophilic)
• T1/2: “longer than morphine” look this up
• Metab: phase 1 liver
• Considerations: elderly: prolonged elimination time d/t ↓ clearance, truncal rigidity/laryngospasm, reflex coughing (stim’s J cells in lungs?)
• Age-related ↓s in hepatic blood flow, microsomal enzyme activity, and albumin production (highly protein-bound)
• phenylpipperdy = truncal rigidity (vs larygneal contracture)

Question 11

Lidocaine

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2, metabolism, considerations

Answer 11

• Dose: 1-1.5 mg/kg *this one you can’t round down, according to 3rd years*
• Standard Concentration: 1% or 2%, 10 mg/mL or 20 mg/mL
• Preparation: 10 mL = 100 mg (or 5 mL = 100 mg)
• Syringe: 5 or 10 mL syringe, depends on vial
• TIP: do calculations for the 1% vial, and if we only have 2% vials, just divide by 2!
• Drug Class/Use: used to blunt SNS response to DL (direct laryngoscopy) and intubation
• Onset:
• Peak: 1-2 minutes
• Duration: 10-20 minutes
• T1/2:
• Metab:
• Considerations: toxicity = ringing in the ears, pt “feels funny”

Question 12

dose, standard concentration, preparation/syringe size, drug class/use, onset, peak, duration, T1/2

• Dose:
• Standard Concentration:
• Preparation:
• Syringe:
• Drug Class/Use:
• Onset:
• Peak:
• Duration:
• T1/2:
• Considerations:

Answer 12

• Dose:
• Standard Concentration:
• Preparation:
• Syringe:
• Drug Class/Use:
• Onset:
• Peak:
• Duration: T1/2:
• Considerations: