Sedatives: Miscellaneous

Question 1

Ketamine (Ketalar)

Onset: less than 1 minute (IV)
Peak effects: variable
Duration: 10-15 minutes (IV)
Half-life: 1-2 hours

MOA: ketamine is thought to cause a dissociation between the cortical and limbic systems, resulting in a seemingly awake patient who is dissociated from the environment. Has analgesic and sedative properties

Answer 1

Class: anesthetic and analgesic

Action: causes dissociative state

Indications: sedation and induction agent for RSI (particularly in children)

Contraindications: known hypersensitivity, significant elevation in BP

Precautions: can cause hallucinations following waking (emergence hallucinations) that can be severe (more particular in adults). This can be avoided if you keep the environment quiet. Ketamine is usually used with a low dose benzo.

Side effects: increased hallucinations, increased skeletal muscle tone, N/V, excessive bronchial secretions

Route: IV, IM

Adult dose: Subdissociative (analgesia)- 0.1-0.3 mg/kg
Dissociative (sedation)- 1.0-4.5 mg/kg IV; 3.0-8.0 mg/kg IM

Peds dose: 0.5-3.0 mg/kg IV, IM

Question 2

Etomidate (Amidate)

Onset: 10-20 seconds
Peak effects: less than 1 minute
Duration: 3-5 minutes
Half-life: 30-70 minutes

MOA: Etomidate produces a rapid induction of anesthesia with minimal respiratory and cardiovascular effects. Unlike other types of sedatives/hypnotics, it does not cause histamine release

Answer 2

Class: sedative and hypnotic

Action: Creates a short-acting sedative/hypnotic effect

Indications: Used as an induction agent in RSI

Contraindications: known hypersensitivity

Precautions: use with caution in pts with marked hypotension, severe asthma, or severe cardiovascular disease

Side effects: myoclonic skeletal muscle movement, apnea, hyperventilation, hypoventilation, laryngospasm, HTN, hypotension, tachycardia, bradycardia, N/V

Interaction: may cause prolonged respiratory depression or apnea

Route: IV

Adult dose: 0.1-0.3 mg/kg IV over 15-30 seconds

Peds dose: greater than 10 years- same as adult dose; less than 10 years- not indicated

Question 3

Propofol (Diprivan)

Onset: 9-36 seconds
Peak effects: 3-5 minutes
Duration: 6-10 minutes
Half-life: 5-12 hours

MOA: produces a rapid induction of anesthesia

Answer 3

Class: sedative and hypnotic

Description: Propofol is an ultra-short-acting hypnotic used as an induction agent in sedation and anesthesia

Indications: used as an induction agent for sedation and intubation and maintenance of sedation

Contraindications: known hypersensitivity, increased ICP

Side effects: hypotension, bradycardia, transient apnea during induction, N/V (recovery phase), headache (recovery phase)

Route: IV, PO

Adult dose: 25-75 mcg/kg PRN

Peds dose: 1mg/kg IV

Question 4

Dexmedetomidine (Precedex)- sedative and hypnotic