MAC - HOLLY'S DOSES - Exam 3

Question 1

Chloroprocaine
-MAC toxic dose

Answer 1

11mg/kg

Question 2

Chloroprocaine
-MAC DOA

Answer 2

15-30 min

Question 3

Chloroprocaine with Epi
-MAC Toxic dose

Answer 3

14mg/kg

Question 4

Chloroprocaine with Epi
-MAC DOA

Answer 4

15-30 min

Question 5

Bupivicaine
-MAC toxic dose

Answer 5

2.5mg/kg

Question 6

Bupivicaine
-MAC DOA

Answer 6

120-240 min
or2-4hr

Question 7

Bupivicaine with Epi
-MAC toxic dose

Answer 7

3mg/kg

Question 8

Bupivicaine with Epi
-MAC DOA

Answer 8

180-420min

AKA 3-7hr for us normal ppl

Question 9

Lidocaine
-MAC toxic dose

Answer 9

4mg/kg

Question 10

Lidocaine
-MAC DOA

Answer 10

30-60min

Question 11

Lidocaine with Epi
-MAC toxic dose

Answer 11

7mg/kg

Question 12

Lidocaine with Epi
-MAC DOA

Answer 12

120-360min

or 2-6hr in normal person language

Question 13

LAST lipid therapy
-MAC bolus dose

Answer 13

1.5mL/ kg
-give repeat doses until “just give the whole bag tbh”-Holly
-notice ML not MG

Question 14

LAST lipid therapy
-MAC infusion dose

Answer 14

0.25mL/kg/min

Question 15

Fentanyl
-MAC dose

Answer 15

0.5-1mcg/kg up to 2mcg/kg

Question 16

Fentanyl
-MAC peak

Answer 16

1.4 min
“I like 90 sec”-Holly

Question 17

Midazolam
-MAC dose

Answer 17

0.5-2mg IV
-before entering OR or ok for short MAC cases

Question 18

Midazolam
-MAC onset and peak

Answer 18

within 2-5min

Question 19

Midazolam
-MAC elimination half life

Answer 19

1-4hr

Question 20

Flumazenil
-MAC reversal dose

Answer 20

0.2mg IV

Question 21

Remifentanil
-MAC infusion(starting rate, wean to, continue weaning…)

Answer 21

0.1mcg/kg/min for 5 min
THEN
wean to 0.05mcg/kg/min and continue weaning for synergy of other drugs

Question 22

Midazolam
-MAC dose elderly pt

Answer 22

50% decrease
~0.25-1mg IV

Question 23

Propofol
-MAC bolus

Answer 23

0.25-0.5mg/kg

Question 24

Propofol
-MAC initiation infusion

Answer 24

100-150mcg/kg/min

Question 25

Propofol
-MAC maintenance infusion

Answer 25

25-75mcg/kg/min

“up to 150 if stuff is crazy”-Holly

Question 26

Ketamine
-MAC bolus

Answer 26

0.25-0.5mg/kg IV

Question 27

Ketamine
-MAC onset, peak, DOA

Answer 27

O: 30-60sec
P: 1min
DOA: 15 min

Question 28

Glycopyrrolate
-dose for MAC Ketamine adjunct

Answer 28

0.2mg IV

Question 29

Dexmedetomidine
-MAC loading dose

Answer 29

0.5-1mcg/kg over 10-20min

Question 30

Dexmedetomidine
-MAC infusion

Answer 30

0.2-1mcg/kg/ HOUR
“Per HOUR is KEY, not per minute” -Holly

Question 31

Dexmedetomidine
-MAC peak and DOA

Answer 31

P: 15-30 min
DOA: 60-120 min (dose dependent)

Question 32

Patient A is a 70 kg male undergoing MAC for I & D of infected finger, your POC is to “balance” the anesthetic. Local anesthetic will be ineffective due to localized infection. What drugs may be used to meet the goals of anesthetic technique?

Answer 32

Opioid for analgesia:
Fentanyl 35-140 mcg IVP
OR Remi 0.1 mcg/kg/min for 5 min, wean to 0.05 mcg/kg/min, continue to wean based on synergy of other drugs

Benzo for anxiolytic, amnestic, +/- hypnosis
Midazolam 1-2 mg IVP

Question 33

What are safe MAC dose ranges of propofol?

Answer 33

Bolus 0.25-0.5 mg/kg
Initiation OF MAC by infusion =100-150 mcg/kg/min
Maintenance infusion = 25-75 mcg/kg/min

Question 34

Your anesthesia POC is to provide minimal sedation/anxiolysis for a patient, what is the drug of choice?

Answer 34

Benzo
Midazolam 1- 2 mg IVP
Oral midazolam 5-15 mg

Question 35

Your anesthesia plan of care is to provide a level of sedation where the patient should still respond purposefully to verbal commands with or without light tactile stimulation. Based on the patient’s PMH, you desire the respiratory and cardiovascular systems remain unaffected. Which medications may provide this level of sedation ensuring analgesia and anxiolysis?

Answer 35

Opioid and benzo!
Fentanyl 25-100 mcg IVP
Midazolam 0.5-2 mg IVP

Think cath lab or what you give when they’re placing a Swan bedside