Txwes Guide BZD/Opioids/Induction/MH

Question 1

BENZOS

Diazepam
Dose (IV, PO), Onset, Duration:

Valium

Answer 1

Valium
0.1mg/kg IV
Onset 1-5mins ⏐Duration 2-6h

0.2mg/kg PO

Question 2

BENZOS

Lorazepam
Dose, Onset, Duration:

Ativan

Answer 2

Ativan
0.04mg/kg ⏐ Onset 1-5mins ⏐Duration 6-10h

Question 3

BENZOS

Midazolam
Dose, Onset, Duration:

Versed

Answer 3

Versed
1-5mg or 0.01-0.05mg/kg ⏐Onset 1-5mins ⏐Duration 15-80min

Question 4

BENZOS

Flumazenil
Dose, Onset, Duration:

Romazicon

Answer 4

Romazicon
0.2mg ⏐ Onset 1-5mins ⏐Duration 30mins!!! (may need redose to outlast BZD)

Repeat 0.1 q 1min –> MAX 3mg

BENZO REVERSAL

Question 5

OPIOIDS

Morphine
Dose (intraOp, postop), Onset, Duration:

Answer 5

1-10mg IntraOp
5-20mg PostOp
Onset 10-20mins ⏐ Duration 4-5h

Question 6

OPIOIDS

Fentanyl
Dose, Onset, Duration:

Answer 6

1.5-3mcg/kg
Onset 30-60sec ⏐ Duration 1-1.5h

Question 7

OPIOIDS

Sufentanil
Dose, Onset, Duration:

Answer 7

0.3-1mcg/kg
Onset 30-60sec ⏐ Duration 1-1.5hr

Infusion: 0.5-1mcg/kg/hr (close to intraop dose)

Question 8

OPIOIDS

Remifentanil
Dose, Onset, Duration:

Answer 8

LOAD: 0.5 - 1mcg/kg OVER 1 MIN!
Onset 30-60sec ⏐ Duration 6-8min

gtt: 0.125-0.375 mcg/kg/min

Question 9

OPIOIDS

Meperidine
Dose, Onset, Duration:

Demerol

Answer 9

Demerol
12.5mg (Shivering)
Onset 5-15min ⏐ Duration 2-4h

Question 10

OPIOIDS

Hydromorphone
Dose (intra, postop), Onset, Duration:

Dilaudid

Answer 10

Dilaudid
1 - 4mg IntraOp
1.5 - 4mg PostOp (basically the same)
Onset 5-15min ⏐ Duration 2-4hr

Question 11

OPIOIDS

Naloxone
Dose, Onset, Duration:

Narcan

Answer 11

Narcan
40-80mcg ⏐ Onset 1-5 min⏐ Duration 30min

Opioid REVERSAL

Question 12

INDUCTION MEDS

Propofol
Dose (induction, sedation gtt, TIVA gtt), Onset, Duration:

Answer 12

1.5-2.5mg/kg Induction
25-100 mcg/kg/min Sedation
100-300 mcg/kg/min TIVA
Onset 30-60sec ⏐ 1-8mins

Question 13

Induction

Etomidate
Dose, Onset:

Answer 13

0.3mg/kg ⏐ Onset 1 min

Question 14

Induction

Ketamine
Dose (induction, IV analgesia), Onset, Duration:

Answer 14

0.5-1.5mg/kg Induction
0.2-0.5 mg/kg IV Analgesia
Onset 1 min⏐ Duration 10-20min

4 - 8 mg/kg IM

Question 15

Induction Dose

Midazolam
Dose, Onset, Duration:

Versed

Answer 15

Versed
0.1-0.2mg/kg Induction
Onset 30-60sec ⏐ Duration 5-10min

*may precede dose w/ Fentanyl 50-100mcg

Question 16

Dexmedetomidine
Dose (Bolus and Infusion):

Precedex

Answer 16

Precedex
Bolus 0.5-1mcg/kg over 10mins
Infusion 0.2 - 0.7 mcg/kg/hr

Usually on-hand 200mcg/2ml > mix with 48cc NS ⇒ 4mcg/ml

Question 17

Inhalation

Sevoflurane
MAC, VP, Blood:Gas Co.:

Answer 17

Ultane
MAC 1.8
VP 157
Blood:gas Coefficient 0.69

Question 18

Inhalation

Desflurane
MAC, VP, Blood:Gas Co.:

Answer 18

Suprane
MAC 6.6
VP 669
Blood:gas Coefficient 0.42

Question 19

Inhalation

Isoflurane
MAC, VP, Blood:Gas Co.:

Answer 19

Forane
MAC 1.17
VP 238
Blood:gas Coefficient 1.46

Question 20

Inhalation

Nitrous Oxide
MAC, VP, Blood:Gas Co.:

Answer 20

MAC 104
VP 🚀 38,770 gas
Blood Coefficient 0.46

Question 21

List triggers for MH.

Answer 21

Volatile Anesthetics & SCh

Question 22

List signs of Malignant Hyperthermia

Answer 22

• tachycardia, tachypnea
• rapidly increasing ETCO2
• muscle rigidity, masseter spasm
• hyperthermia
• skin mottling

Question 23

List the treatment regimen for MH.

Answer 23

1. STOP THE TRIGGER
2. 100% O₂ hyperventilation
3. Dantrolene 2.5mg/kg IV (repeat 5-10mins; MAX 10mg/kg)
4. Actively cool pt
5. correct hyperkalmia and metabolic acidosis
6. Monitor labs and maintain UO >2cc/kg/hr (hydration, mannitol, lasix) watch for rhabdo

Question 24

What is the dose of Dantrolene for MH?

Answer 24

2.5mg/kg IV (repeat q5-10mins prn)

MAX 10mg/kg