Neuraxial Drugs Flashcards
What opioids (with respective doses) are often used in spinal anesthesia?
- Morphine 100 - 400 mcg
- Fentanyl 10 - 25 mcg
- Sufentanil 2.5 - 10 mcg
What opioids (with respective doses) are often used in epidural anesthesia?
- Morphine 3 - 5 mg
- Fentanyl 50 - 100 mcg
- Sufentanil 10 - 25 mcg
How is neuraxial pruritis treated?
- Diphenhydramine 25 - 50 mg IV
- Naloxone 0.1 mg IV (best but reverses pain control)
How is neuraxial pruritis prevented?
- Minimize morphine dose
- Ondansetron 4 mg IV
- Nalbuphine 2.5 - 5 mg IV
Morphine doses of < 100mcg will have a lower incidence of _______.
PONV
What is the epi wash dose?
Why is it used?
- 0.2 - 0.3 mg
- Used to prolong duration of neuraxial medication.
What is the neo wash dose?
2 - 5 mcg
What drug exhibits a much more profound increase in duration when vasopressors are used with it?
Tetracaine
What is the neuraxial dose of clonidine?
15 - 45 mcg
What is the neuraxial dose of dexmedetomidine?
3 mcg
What is the dose for lipid rescue?
1.5 mL/kg bolus
0.25 mL/kg gtt
What dose of caffeine is given for PDPH?
300 - 500mg PO or IV
Local Anesthetic Dosing/ Duration Chart
Name the dosage of the following adjunct agent for a spinal block:
Morphine
Fentanyl
Sufentanil
- Morphine 100-400 mcg (24 hrs)
- Fentanyl 10-25 mcg
- Sufentanil 2.5-10 mcg
Name the dosage of the following adjunct agent for an epidural block:
Morphine
Fentanyl
Sufentanil
- Morphine 3-5 mg (24 hrs)
- Fentanyl 50-100 mcg
- Sufentanil 10-25 mcg
Higher doses required when given by the epidural route
What are the treatments for pruritus from neuraxial opioids?
- Benadryl 25-50 mg IV
- Naloxone 0.1 mg IV (best)
- Buprenex (mixed agonist/antagonist)
Although Naloxone is the best treatment for pruritus, it will also reverse the analgesic properties of the opioid resulting in the patient being in pain.
What are prophylactic managements for pruritus from neuraxial opioids?
- Minimize the dose of morphine to < 300 mcg
- Ondansetron 4 mg IV
- Nubain 2.5-5.0 mg IV
Neuraxial opioids can be reversed with what medication?
- Naloxone 0.1-0.2 mg
PONV from neuraxial opioids is very dose-dependent. What is the recommended neuraxial dose of morphine?
- < 300 mcg
- At less than 100 mcg N/V will almost be absent
What is the treatment for PONV from neuraxial opioids?
- Ondansetron (5 HT antagonist) 4-8 mg
- Naloxone 0.1 mg
- Phenergan 12.5- 25 mg IM
What is the dose for an “epi wash”?
What is the dose for a “neo wash”?
- Epinephrine 0.2 - 0.3 mg
- Neosynephrine 2-5 mcg
If a craniotomy requires a trans-ethmoidal approach, what medication can be given to prevent the VX Mechansim?
- Glycopyrrolate, Rubinol (↑ HR)
α2-adrenergic agonist neuraxial dosage
Clonidine
Dexmedetomidine
α2-adrenergic agonist neuraxial dosage
Clonidine 15-45 mcg
Dexmedetomidine 3 mcg
Opioid neuraxial dosage
Morphine
Fentanyl
Sufentanil
Opioid neuraxial dosage
Morphine 0.1-0.4 mg
Fentanyl 10-25 mcg
Sufentanil 2.5-10 mcg
