opioids Flashcards
fentanyl dose for induction sympathectomy/analgesia
1-2 mcg/kg
remifentanil dose for induction
0.5 - 1 mcg/kg (IBW!)
remifentanil dose for GA infusion
0.02 - 2 mcg/kg/min
turn off 6 min before breathing and give longer like fentanyl acting for PACU
sufentanil dose for analgesia
0.1 - 0.4 mcg/kg
sufentanil dose for induction
0.5 - 1 mcg/kg IV or 0.2 - 0.5 mcg/kg/hr infusion
which ones use lungs as first-pass metabolism?
fentanyl (75%)
remifentanil (75%)
sufentanil (60%)
rank the fents (compared to morphine)
sufentanil (1000x) > fentanyl & remifentanil (100x) > alfentanil (20x) > dilaudid (5x) > morphine
alfentanil dose
250 or 500 mcg IV
onset and duration of remifentanil
onset: 1.1 mins (quickest of all the fents!)
duration: 5-10 mins
how is remifentanil metabolized?
hydrolysis via plasma/tissue esterases = lack of accumulation
- 75% first pass uptake into lungs
onset and duration of sufentanil
onset: seconds with peak at 4 mins
duration: 20 mins
when do you want to stop sufentanil infusions to ensure emergence?
45 mins before end of case
post op dose for morphine
5-20 mg IV
onset and duration of morphine
onset: 3 mins with peak at 15 mins
duration: 2-4 hours
how is morphine metabolized? what are its metabolites?
Via glucoronidation! into M3G and M6G (active)
morphine increases production of what hormone?
ADH
what is one of the most important precautions r/t morphine?
causes histamine release
how is dilaudid metabolized?
Via glucuronidation! into hydromorphone-3-glucuronide (ACTIVE)
which opioid is safer with renal failure pts, morphine or dilaudid?
dilaudid - does not accumulate like morphine does
what’s meperidine (Demerol) used for?
dose?
post-op shivering
dose: 25-50 mg
