Anesthesiology Quick Reference (Adult) 2013

AGENT Sedation Induction Maintenance (IV) IV OPIOIDS Sedation Loading Induction Maintenance

Midazolam 0.01-0.05 mg/kg 0.1-0.4 mg/kg 0.25-1 mcg/kg/min Morphine 0.05-0.2 mg/kg 0.2-0.5 mg/kg 1-3 mg/kg 0.05-0.1 mg/kg/hr
0.05-0.1 mg/kg IM Fentanyl 1-2 mcg/kg 2-5 mcg/kg 15-40 mcg/kg 1-2 mcg/kg/hr
0.5-1 mg/kg PO
Remifentanil 0.02-0.2 mcg/kg/min 0.5-5 mcg/kg 0.05-2 mcg/kg/min
Propofol 0.5-1 mg/kg 1.5-2.5 mg/kg 50-200 mcg/kg/min
Sufentanil 0.1-0.3 mcg/kg 0.25-2 mcg/kg 2-20 mcg/kg 0.3-1.5 mcg/kg/hr
Thiopental 1-2 mg/kg 3-6 mg/kg 2-6 mg/kg/hr
PARALYTICS Clearance Intubating Duration Maintenance
Etomidate 0.2-0.5 mg/kg
Succinylcholine Pseudo 0.6-2 mg/kg 5-10 min
Ketamine 0.25-0.5 mg/kg 1-2 mg/kg 1-2 mg/kg/hr 3-4 mg/kg IM
1 mg/kg PO 5-10 mg/kg IM
Vecuronium Liv>>Kid 0.1 mg/kg 20-35 0.05-0.07 mg/kg/hr
Dexmedetomidine 0.2-0.7 mcg/kg/hr Rocuronium Liv>>Kid 0.6-1.2 mg/kg 20-35 0.6-0.7 mg/kg/hr
Scopolamine 0.05 mg/kg Cisatracurium Hoffman 0.15 mg/kg 20-35 0.06-0.18 mg/kg/hr
Diphenhydramine 0.5 mg/kg Pancuronium Kid>>Liv 0.1 mg/kg 60-90 0.01-0.03 mg/kg/hr

VASOACTIVE Bolus / Loading (Typical) Mix in 250cc Maintenance INHALED MAC Blood: Fat::
AGENTS (Concentration) AGENTS (Adult @ 1 atm) Gas Blood

Atropine mACh 0.5-1 mg Halothane 0.8% 2.4 60

Ephedrine β>α1 0.1 mg/kg (5-10 mg) Isoflurane 1.2% 1.4 45

Sevoflurane 2% 0.65 48
Phenylephrine α 1 mcg/kg (50-200 mcg) 20mg (80 mcg/mL) 0.1-1.0 mcg/kg/min
Desflurane 6% 0.42 27
Dopamine D1>β1>α 400 mg (1.6 mg/mL) 2-20 mcg/kg/min
Nitrous Oxide 105% 0.47 2.3
Norepinephrine α>β1 0.1 mcg/kg (10-50 mcg) 4 mg (16 mcg/mL) 0.05-0.5 mcg/kg/min
ANTIEMETICS Dose
Epinephrine β>α 0.1-10 mcg/kg (5-100 mcg) 4 mg (16 mcg/mL) 0.01-0.5 mcg/kg/min ASPIRATION
Dose
Ondansetron 4 mg IV PROPHYLAXIS
Vasopressin V1>V2 0.01-0.05 U/kg (0.5-2 U) 40 U (0.16 U/mL) 0.02-0.1 U/kg/hr
Dexamethasone 4-10 mg IV
Dobutamine β 250 mg (1 mg/mL) 2-30 mcg/kg/min Sodium Citrate 30 mL
Prochlorperazine 5-10 mg IV
Milrinone PDEI 50 mcg/kg 50 mg (200 mcg/mL) 0.375-0.75 mcg/kg/min Famotidine 20 mg
Droperidol 0.625 mg IV
Isoproterenol β 0.5-1 mcg/kg (20-60 mcg) 2 mg (8 mg/mL) 0.01-0.1 mcg/kg/min Metoclopramide 10 mg
Scopolamine 1.5mg TD
Labetalol β>α1 0.1-0.25 mg/kg (5-10 mg) q 2-6 hr
OTHER AGENTS Dose
Metoprolol β1>β2 0.01-0.3 mg/kg (1-10 mg) q 4-8 hr
Glycopyrrolate 0.01-0.015 mg/kg
Esmolol β1>β2 0.25-1 mg/kg (20-50 mg) 2500 mg (10 mg/mL) 0.05-0.2 mg/kg/min Neostigmine 0.04-0.08 mg/kg
Propranolol β 0.005-0.01 mg/kg (0.5-1 mg) Physostigmine 0.01-0.03 mg/kg
Hydralazine GC 0.03-0.07 mg/kg (2.5-5mg) Naloxone 0.04-0.4 mg→ 0.1-1.0 mg/hr
Flumazenil 0.1-0.3 mg → 0.3-0.5 mg/hr
Nitroglycerin NO 0.5-1.5 mcg/kg (25-100 mcg) 100 mg (400 mcg/ml) 0.5-8 mcg/kg/min
Calcium Chloride/Gluconate 5-15 mg/kg / 15-30 mg/kg
Nitroprusside NO 0.5-1.5 mcg/kg (25-100 mcg) 50 mg (200 mcg/mL) 0.5-8 mcg/kg/min Magnesium Sulfate 15-25 mg/kg
Nicardipine CCB 0.25-0.5 mg 25 mg (100 mcg/mL) 5-15 mg/hr Dextrose 0.5-1 g/kg
Phentolamine α 10-70 mcg/kg (1-5 mg) 1-30 mcg/kg/min Glucagon 1 mg IV/IM

Fenoldopam D1 0.1-1.0 mcg/kg/min Octreotide 50-100 mcg/hr

Enalaprilat ACEI 0.625-1.25 mg Sodium Bicarbonate 0.5-1 meq/kg

Phenytoin 10-20 mg/kg
Nitric Oxide NO 2-80 ppm
Mannitol 0.25-2 g/kg
Adenosine AC 6 / 12 / 12 mg
Methylene Blue 2 mg/kg → 0.5 mg/kg/hr
Diltiazem CCB 15-20 / 20-25 mg 5-15 mg/hr
Terbutaline 0.25 mg SC
Amiodarone CCB/BB 150-300 mg 60 mg/hr → 30 mg/hr
Methylergonovine 0.2 mg IM
Verapamil CCB 2.5-5 mg Carboprost 250 mcg IM
Oxytocin 10-40 U IVSS
Digoxin SPA 0.5 → 0.25 → 0.25 mg
Albuterol 2.5 mg nebulized
Lidocaine SCB 50-100 mg 60-240 mg/hr Ipratropium 0.25 mg nebulized
LOCAL Duration (hrs) Max Dose (mg/kg) CVS: CNS ANTICOAGULANTS Drug-Free Days Prior to Neuraxial Block
ANESTHETICS Spinal Epidural Peripheral (+Epi = 1:200k=5 mcg/mL) Toxicity
Heparin IV - 4 hr Rivaroxiban - 3 to 7 Clopidogrel - 7
Chloroprocaine 2-3% 1-1.5 0.5-1.5 - 12 4 Enoxaparin - ½ to 1 Ticagrelor - 5 Prasugrel - 7 to 10
Lidocaine 1-2% 1-1.5 1.5-2.5 2-4 4.5 (7) 7 Apixiban - 2 Dabigatran - 5 to 7 Ticlopidine - 14
Mepivacaine 1-1.5% 1-1.5 1-3 3-5 4.5 (7) 7
EMERGENCY Immediate Treatment Options to Consider
Bupivacaine 0.25-0.75% 1-3 3-5 6-12 3 2 PROTOCOLS

Ropivacaine 0.2-1% - 2-6 5-8 3 2 Difficult call for help (anesthesia, ENT), consider awaken-
Ventilation/ ing patient, change position/practitioner/device
Tetracaine 1% 2-6 - - 3 Intubation (blade, fiberscope, Glidescope, LMA, FasTrach),
cricothyrotomy
ANALGESICS Equianalgesics Adult Initial Dose COMBO
Anaphylaxis epinephrine 0.5mg SC (or IV dosing PRN), hydro-
ANALGESICS
Morphine 10 mg IV 4-15 mg IV q 3-4 hr cortisone 100mg, diphenhydramine 50mg, famo-
tidine 20mg, albuterol, vasopressin, glucagon,
30 mg PO 5-20 mg PO q 3-4 hr Vicodin Acetaminophen 325 +
blood sample for tryptase
4 mg EPI 0.25 mg IT Hydrocodone 5 PO q4hr
Malignant Hyperventilate 100% O2, dantrolene 2.5-10mg/kg,
Fentanyl 0.1 mg IV 50-150 mcg IV q 1 hr Percocet Acetaminophen 325 + Hyperthermia cooling, hydration, NaHCO3, glucose/insulin/
100 mcg EPI 25 mcg IT Oxycodone 5 PO q 4 hr CaCl, 1-800-MH-HYPER

Hydromorphone 1.5 mg IV 0.2-0.6 mg IV q 2-4 hr Hemolytic stop xfusion, hydration, NaHCO3, vasopressors
Tylenol #3 Acetaminophen 325 + Transfusion PRN, steroids, retain blood and pt sample for
7.5 mg PO 2-4 mg PO q 4-6 hr Codeine 30 PO q 4 hr Reaction analysis
1 mg EPI 0.15 mg IT
Pulseless CPR (30 compress [100+/min]:2 vent [8-10 with
Methadone 10 mg IV 2.5-10 mg IV q 3-6 hr STEROIDS Equivalents Ventricular ETT])
20 mg PO 2.5-10 mg PO q 3-12 hr Tachycardia/ 200J biphasic (360J mono) defibrillation X1
Ventricular continue 5 cycles (2 min) CPR + 1 shock
Hydrocodone 30 mg PO 5-10 mg PO q 4-6 hr Hydrocortisone 20 mg Fibrillation epinephrine 1 mg q 3-5min, vasopressin 40U X1
amiodarone 300/150mg
Oxycodone 20 mg PO 5-15 mg PO q 4-6 hr lidocaine 100 mg X2
Prednisone 5 mg
consider NaHCO3, MgSO4, CaCl2
Codeine 200 mg PO 30-60 mg PO q 4-6 hr
Asystole continuous CPR
Meperedine 75 mg IV 12.5-25 mg IV for shivering Methylprednisolone 4 mg PEA epinephrine 1mg q 3-5min, vasopressin 40U X1
consider NaHCO3, CaCl2
Acetaminophen 1000 mg PO/IV 500-1000 mg PO/IV q 4-6 hr
Post- avoid hyperthermia/hyperventilation/
Ketorolac 30 mg IV 15-30 mg IV q 6 hr Dexamethasone 0.75 mg Resuscitation hyperglycemia
consider hypothermia to 32-34ºC
Ibuprofen 800 mg PO 400-800 mg PO q 6-8 hr consider continued antiarrhythmics

PATIENT-CONTROLLED ANALGESIA Tachycardia synchronized cardioversion 50-200J if unstable

Narrow complex: adenosine 6/12 mg, esmolol/
IV Morphine 1.4mg q 8 min [ +/- 1 mg/hr ] metoprolol/diltiazem/verapamil/digoxin/
amiodarone
IV Fentanyl 18 mcg q 8 min [ +/- 10 mcg/hr ] Wide complex: amiodarone 150mg, MgSO4 1-2g
IV Hydromorphone 0.2mg q 8 min [+/- 0.1 mg/hr] Bradycardia atropine 0.5mg (3mg max), dopamine, epineph-
rine, isoproterenol, transcutaneous/transvenous
Epidural [Fentanyl 5 mcg/mL+ Bupivacaine 0.1%] @ 6 mL/hr + 2mL q 20 min PRN pacing
Peripheral Nerve Block [Bupivacaine 0.1%] @ 8 mL/hr + 2 mL q 30 min PRN Myocardial O2, aspirin, β-blocker, NTG, morphine
Ischemia cardiology evaluation for possible intervention
FLUID MANAGEMENT COAGULATION Dose
CHF/Edema O2, furosemide, morphine, NTG, NTP, milrinone/
Maintenance (kg wt + 40) mL/hr Desmopressin 0.3 mcg/kg IV dopamine, IABP, BiPAP
Deficit Time NPO x Maintenance Asthma O2, albuterol, ipratropium, steroids, terbutaline,
Replace 1/2 in 1st hr, 1/4 in 2nd & 3rd Protamine 1mg IV per 100 U Heparin COPD epinephrine, MgSO4, BiPAP, volatile anesthetics
hr
Aminocaproic 75-150 mg/kg→15-30mg/kg/hr Stroke O2, treat hyperglycemia & severe hypertension,
Blood Loss & Lap Pad = ~100mL / Sponge = ~15mL Acid neurology consult for CT scan and medical/
Replacement 1:1 Colloid (RBC, FFP, HES, Albumin) surgical intervention
3:1 Crystalloid Tranexamic 10 mg/kg → Repeat in 3 hrs
Acid 10 mg/kg → 1 mg/kg/hr Seizures midazolam, propofol/thiopental, phenytoin, GA,
Insensible Loss 3-9 mL/kg/hr MgSO4 (for eclampsia)
Urine Output 0.5-1 mL/kg/hr Factor 7a 90 (30-120) mcg/kg Q3-6hr
Hypertensive 10-20% BP reduction with NTP, nicardipine,
Fluid Composition LR - 130 Na/109 Cl/4 K/3 Ca/28 Lactate Heparin 80 U/kg → 15 U/kg/hr Emergency labetalol
PLA - 140 Na/98 Cl/5 K/3 Mg/23 Gluconate
NS - 154 Na/154 Cl Hyperkalemia CaCl2, insulin/dextrose, NaHCO3, hyperventila-
INSULIN Onset / Peak / Duration tion, β-agonists, dialysis, kayexalate
Estimated Blood Vol 60-75 mL/kg
Tension Large bore needle decompression in midline of
Allowable Blood Loss (HctStart-HctLimit) x EBV / HctStart Aspart/Lispro/ 15min / 1hr / 4hr Pneumothorax hemithorax at level of sternal angle with needle to
Glulisine (SC) 1-7 cm depth, chest tube thoracostomy
PRBC Transfusion (HctGoal-HctNow) X EBV / 0.7
Volume Fetal O2, reposition mother, ephedrine/phenylephrine
Regular (SC) 20min / 2hr / 6hr Distress (for hypotension), NTG + stop oxytocin (for uterine
Ideal Body Weight IBW=50♂/45♀ kg + 2.3 kg per inch >5’ Regular (IV) 1min / 3min / 15min tetany), pelvic exam, instrument/surgical delivery
Lean Body Weight LBW=(kg - IBW) x 25% + IBW
Body Surface Area BSA= (cm * kg / 3600)1/2 NPH (SC) 2hr / 8hr / 21hr Local Anesth 20% IV fat emulsion 1.5 mL/kg → 0.25 mL/kg/
Body Mass Index BMI= (kg weight) / (m height)² Glargine/Detemir (SC) 4hr / 12hr / 20hr Toxicity min X 30-60 minutes