Anesthetics / Sedatives

Anesthetics /Sedatives

dexmedetomidine (Precedex ®)	etomidate (Amidate ®)
ketamine (Ketalar ®)	methohexital (Brevital ®)
pentobarbital (Nembutal ®)	propofol (Diprivan ®)
thiopental (Pentothal ®)

dexmedetomidine (Precedex ®)

Alpha2-adrenergic agonist sedative.
Dosing (adults):
ICU sedation: Initial: Loading infusion of 1 mcg/kg IV over 10 minutes, followed by a maintenance infusion of 0.2-0.7 mcg/kg/hour (individualized and titrated to desired clinical effect); not indicated for infusions lasting >24 hours (Solution must be diluted prior to administration.)

Supplied: 100 mcg/ml - 2 ml Injection

etomidate (Amidate ®)

Ultrashort-acting nonbarbiturate hypnotic.
Dosing (adults):
Anesthesia: Initial: 0.2 to 0.6 mg/kg IV over 30-60 seconds for induction of anesthesia; maintenance: 5-20 mcg/kg/minute. Produces rapid induction of anesthesia with minimal cardiovascular effects.

Onset of action: 30-60 seconds.
Peak effect: 1 minute.
Duration: 3-5 minutes ( terminated by redistribution).

Supplied: 2 mg/ml (10 ml, 20 ml) injection.

ketamine (Ketalar ®)

Produces a cataleptic-like state in which the patient is dissociated from the surrounding environment by direct action on the cortex and limbic system. Releases endogenous catecholamines (epinephrine, norepinephrine) which maintain blood pressure and heart rate. Reduces polysynaptic spinal reflexes.

Dosing (adults): Anesthesia (sedation, analgesia): IM: 3-8 mg/kg. IV: Range: 1-4.5 mg/kg; usual induction dosage: 1-2 mg/kg.
Maintenance: Supplemental doses of 1/3 to 1/2 of initial dose.

Onset of action: (IV): General anesthesia: 1-2 minutes; Sedation: 1-2 minutes. (IM): General anesthesia: 3-8 minutes.
Duration: 5-15 minutes IV; 12-25 minutes IM.

Supplied: Injection, solution: 50 mg/ml (10 ml); 100 mg/ml (5 ml). Ketalar®: 10 mg/ml (20 ml); 50 mg/ml (10 ml); 100 mg/ml (5 ml).

methohexital (Brevital ®)

Ultra short-acting IV barbiturate anesthetic.

Dosing (adults): Anesthesia: IV: Induction: 50-120 mg to start; 20-40 mg every 4-7 minutes. (doses must be titrated to effect).

Onset: IV: Immediately
Duration: Single dose: 10-20 minutes

Supplied: 500 mg, 2.5 g, 5 gram (powder for reconstitution)

pentobarbital (Nembutal ®)

Short-acting barbiturate with sedative, hypnotic, and anticonvulsant properties.

Dosing (adults): Hypnotic: IM: 150-200 mg. IV: Initial: 100 mg, may repeat every 1-3 minutes up to 200-500 mg total dose. Preoperative sedation: IM: 150-200 mg.

Barbiturate coma in head injury patients or status epilepticus: IV: Loading dose: 5-10 mg/kg given slowly over 1-2 hours; monitor blood pressure and respiratory rate; maintenance infusion: initial: 1 mg/kg/hour; may increase to 2-3 mg/kg/hour; maintain burst suppression on EEG. Status epilepticus: IV: Loading dose: 2-15 mg/kg given slowly over 1-2 hours; maintenance infusion: 0.5-3 mg/kg/hour.

Onset: IM: 10-15 minutes. IV: ~ 1 minute.
Duration: IV: 15 minutes

Supplied: Injection: 50 mg/ml (20 ml, 50 ml).

propofol (Diprivan ®)

Dosing (adults):
Induction: General anesthesia: ASA I or II, <55 years: 2-2.5 mg/kg IV (~40 mg every 10 seconds until onset of induction). Cardiac anesthesia: 0.5-1.5 mg/kg IV (~20 mg every 10 seconds until onset of induction). Neurosurgical patients: 1-2 mg/kg IV (~20 mg every 10 seconds until onset of induction).

Maintenance: ASA I or II, <55 years: IV infusion: Initial: 150-200 mcg/kg/minute for 10-15 minutes; decrease by 30% to 50% during first 30 minutes of maintenance; usual infusion rate: 100-200 mcg/kg/minute (6-12 mg/kg/hour). IV intermittent bolus: 20-50 mg increments as needed.

ICU sedation in intubated mechanically-ventilated patients: Avoid rapid bolus injection; individualize dose and titrate to response. Continuous infusion: Initial: 0.3 mg/kg/hour (5 mcg/kg/min); increase by 0.3-0.6 mg/kg/hour (5-10 mcg/kg/min) every 5-10 minutes until desired sedation level is achieved; usual maintenance: 0.3-4.8 mg/kg/hour (5-80 mcg/kg/min) or higher.

Onset: Anesthetic: Bolus infusion (dose dependent): 9-51 seconds (average 30 seconds).
Duration (dose and rate dependent): 3-10 minutes.

Supplied: Injection: 10 mg/ml (20 ml, 50 ml, 100 ml).

thiopental (Pentothal ®)

Dosing (adults):
Anesthesia: IV: Induction: 3-5 mg/kg.
Maintenance: 25-100 mg as needed. Increased intracranial pressure: IV: Children and Adults: 1.5-5 mg/kg/dose; repeat as needed to control intracranial pressure.

Seizures: I.V.: 75 to 250 mg/dose, repeat as needed.

Renal dosing: crcl <10 ml/minute: Administer 75% of normal dose.

Onset: Anesthetic: IV: 30-60 seconds.
Duration: 5-30 minutes.

Supplied: Powder for reconstitution: 250 mg, 400 mg, 500 mg, 1 g.

Disclaimer

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David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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