● ONSET &

DRUG DOSAGE DURATION NOTES

OF ACTION (DOSE CALCULATION SHORTCUT
# (and usual dilution(s)) (IV and adult unless mentioned and more)
otherwise) (of IV dose, unless
(the ones most commonly used in MH and CMH mentioned
Rawalpindi)
(Sources: Morgan & Mikhail’s, Oxford Handbook of otherwise)
Anaesthesia, MedScape, UpToDate)

PREMEDICATION
ANALGESICS
Nalbuphine 0.1- 0.2 mg/kg O: 2 – 3 min 1/10th THE WEIGHT
(1 mg/mL) max: 0.5mg/kg D: 3 – 6 hr ADR: resp. depression
Preg: D
Morphine IV: 0.03 – 0.15 mg/kg O: < 5 min 1/10th THE WEIGHT
(1 mg/mL) IM: 0.05 – 0.2 mg/kg D: ADR: central cough
suppression
Preg: D
Fentanyl IV: 2 – 50 µg/kg O: few seconds
IM: 0.5 – 1.5 µg/kg D: 0.5 – 1 hr
Tramadol 100 mg bolus O:
(Campex®) 50 mg increments every 10 – 20 min D:
(10 mg/mL) (if needed)
Paracetamol/Acetaminophen 12.5 – 15 mg/kg O: 5 – 10 min Preg: A/B, prolonged maternal
(10 mg/mL) D: 4 -6 hr use may cause asthma in child
Ketorolac IV: 30 mg in adults O: 30 min IV: 15 mg in elderly
(Toradol®) IV maint.: 15 – 30 mg every 6 hr D: 4 – 6 hr Preg: C, D in 3rd Trimester as it
(3 mg/mL) IM: 60 mg can cause premature closure of
Ductus Arteriosus

ANTIEMETICS
Metoclopramide 10 mg stat (adults) O: 1 - 3 min QUARTER THE WEIGHT
(Maxolon®) 0.25 mg/kg D: 1 – 2 hr ADR: sedation
(5 mg/mL) Preg: safe throughout
pregnancy except during
delivery during which it may
cause neonatal extrapyramidal
signs and methemoglobinemia
Ondansetron If < 80 kg: 4 mg O: 30 min ADR: headache is the most
(1 mg/mL) If > 80 kg: 8 mg D: common
Children: 0.1 mg/kg Preg: A/B
Dexamethasone 0.1 – 0.5 mg/kg O: few seconds HALF THE WEIGHT
(Deltacortril, Decadron®) D: 72 hr ADR: painful during IV injection
(4 mg/mL) Preg: C
Domperidone Adult:
 PO: 10 – 20mg 4 to 6 hrly
PR: 30 – 60 mg 4 to 6 hrly
Child:
PO: 200 – 400 µg/kg 6 to 8 hrly
SEDATIVES
Midazolam Anti epileptic:0.01 – 0.1 mg/kg O: 3 – 5 min HALF THE 1/10th OF WEIGHT
(Dormicum®) Sedative: 2 mg stat D: < 2 hr Preg: D
(1 mg/mL)
Dexmedetomidine loading: 1 µg/kg over 10 min then O: 5 – 10 min Loading: WEIGHT IN µg
(Precedex®) maint.: 0.2 – 0.7 µg/kg/hr D: 1 – 2 hr Maint.: HALF THE WEIGHT IN
µg/hr
Caution in hepatic or renal
impairment
Preg: C
Haloperidol ICU Delirium O: 30 – 60 min . NOT recommended in
(Serenace®) IV/IM: 2 -10 mg bolus 4 – 8 hrly D: children
0.05 – 0.15 mg/kg/day . Half the dose in elderly.
(max: 18 mg/day) . ADRs: Extrapyramidal
symptoms. Neurolept
malignant synd..
Preg: C/D

Thiopentone/ Thiopental Induction/Cerebral protection O: Important ADR is hypOtension.

Adult: 3 – 5 mg/kg D:
Neonate: 2 – 4 mg/kg
Child: 5 – 6 mg/kg
Anticonvulsant
Adult: 0.5 – 2 mg/kg
Neonate/Child: 2 – 4 mg/kg then 8
mg/kg/hr
CORTICOSTEROIDS
Dexamethasone General O: CIed in Myasthenia Gravis.
(Decadron®) Adult: IV/IM/SC 4 – 8 mg D: Preg: C
(4 mg/mL) Child: IV/IM/SC 200 – 400 µg/kg 12
hrly
Cerebral Oedema
Adult: 8 – 16 mg then 5 mg 6 hrly
Child:
Antiemesis
Adult: 2 – 8 mg
Child: 150 µg/kg (max: 8 mg)
Hydrocortisone Adult: IV/IM 50 – 200 mg 6 hly O: Preg: C
(Solu-Cortef®) For adrenal suppression and D:
(10 mg/mL, 20 mg/mL) surgery
25 mg at induction, then 25 mg 6
hrly
 Child: 4 mg/kg then 2 – 4 mg/kg 8
hrly
ANTIBIOTICS
Ceftriaxone, Cefoperazone Intra-abdominal Infections: Preg: B
(100 mg/mL) 1 – 2 g stat or divided 12 hrly
Co-amoxiclav 1.2 g stat Preg: B
(60 mg/mL)

Metronidazole Anaerobic Infections: Preg: B

(4 mg/mL) Loading: 15 mg/kg
Maint.: 7.5 mg/kg over 1 hr 6 hrly
(for 7 – 21 days)
Vancomycin 500mg 6 hrly Preg: No studies conducted.
1g 12 hrly NOT recommended by FDA.
15 mg/kg stat then
10 mg/kg 12 hrly
Ciprofloxacin Intra-abdominal, Skin Related, Preg: C
Lower Resp. tract Infections &
Severe UTI:
400 mg IV 12 hrly for 7 – 14 days
200 mg stat IV
Amikacin 500 mg IV 12 hrly Preg: D

Sulbactam + Cefoperazone 2 g IV 12 hrly Preg: B (for both)

(Sulzone®)
(100 mg/mL, 200 mg/mL)
Linezolid 600 mg IV 12 hrly Preg: C
(Nezkil®)
Meropenem 1g IV 8 hrly Preg: B

Gentamicin 80 mg spray SOS Preg: D

Tazobactam + Piperacillin 4.5 g IV 8 hrly Preg: B (for both)

(Tazocin®)
HEMOSTATIC AGENTS
Tranexamic acid 500 mg – 1 g slow IV 8 hrly O: Preg: B
(100 mg/mL) 10 – 15 mg/kg slow IV 8 hrly D:
Oxytocin 20 IU bolus O: Bolus will cause
(5 U/mL, 10 U/mL) then D: . hypotension and reflex
80 IU in NS over 4 hr tachycardia
. Painful, administer IV slowly
Oxford Handbook dose: Preg: X
5 IU slow IV
then if required
10 IU/hr (40 IU in 40 ml NS)
ANTIEPILEPTICS
Phenytoin Adults O: 0.5 – 1 hr - Slow IV only (max 50 mg/min)
 Loading: 10 - 15 mg/kg D: - Loading dose NOT
then recommended in renal or
Additional: 5 - 10 mg/kg (after 10 hepatic impairment
min if needed) Preg: X (teratogenic, known to
then cause foetal facial
Maint.: 100mg abnormalities)
Children
15 -20 mg/kg single or divided
then
4 - 8 mg/kg/day divided twice daily

Levetiracetam 500 mg 12 hrly O: Preg: C

(Lerace®) D:
(50 mg/mL)

? MgSO4 Eclampsia Prophylaxis O: ADR: causes hypOkalemia

(500 mg/mL) IV: 4 - 5 g in 250 mL NS inf. IV: seconds Preg: D (known to cause
then either IM: 1 hr neonatal skeletal
a: IM 5 g in each buttock or D: demineralization with
b: IV 1 – 3 g/hr inf. IV: 30 min prolonged use in preggo)
IM: 3 – 4 hr
For HypOmagnesemia
Adult:
Mild: IM 1g 6 hrly
Severe:
Loading: IV 5 g over 3 hr
then
maint.: IV 30 – 60 mg/kg/day
Child:
IV/IM: 25 – 50 mg/kg 4 or 6 hrly in
3 – 4 divided doses

Thiopentone/ Thiopental Anticonvulsant O: Important ADR is hypOtension.

Adult: 0.5 – 2 mg/kg D:
Neonate/Child: 2 – 4 mg/kg then 8
mg/kg/hr

MISCELLANEOUS
Omeprazole 20 mg, 40 mg O: Preg: C
(2 mg/mL, 4 mg/mL) D:
Ranitidine 50 mg stat O: 1 – 2 hr Preg: B
(25 mg/mL) D: 10 – 12 hr
Non particulate Antacids 15 – 30 mL O: 5 – 10 min
(Bacitra, Polycitra) D: 30 – 60 min
INDUCTION
Propofol Induction: 1 – 2.5 mg/kg O: 30 – 45 s DOUBLE THE WEIGHT
(10 mg/mL) Maint.: 50 – 200 µg/kg/min D: 3 – 10 min . has anticonvulsant activity
Sedation: 25 – 100 µg/kg/min ADRs: hypOtension and apnoea
Preg: B
Etomidate Induction: 0.2 – 0.5 mg/kg O: < 1 min HALF THE WEIGHT
(2 mg/mL) D: 3 – 5 min Cardiostable (does NOT cause
hypotension)
Preg: C
Ketamine IV Induction: 1 – 2 mg/kg O: 30 s IV: TWICE THE WEIGHT
(10 mg/mL) IM Induction: 5 – 7 mg/kg D: 5 – 10 min IM: SIX TIMES THE WEIGHT
Sedation in combo with propofol: Preg: C
2.5 – 15 µg/kg/min
IV Sedation: 0.2 – 0.5 mg/kg
IV Analgesia: 0.5 – 1 mg/kg

MUSCLE RELAXANTS
Succinylcholine/ Intubation: 1 mg/kg O: 0.5 – 1 min WEIGHT in mg
Suxamethonium Incremental: 0.15 mg/kg (if needed) D: 4 – 6 min CIs: in GBS, MS, Duchenne MD
(Scoline®) Maintenance: 2 – 15 mg/min and Becker MD.
(20 mg/mL) Intubation in MG: 1.5 - 2 mg/kg Preferred instead of NDMRs in
MG in larger than usual dose
(as shown)
Preg: A/B, no animal or human
studies available
Atracurium Intubation: 0.5 mg/kg O: 2.5 – 3 min Intubation: HALF THE WEIGHT
(Tracrium®) Incremental: 0.1 mg/kg (if needed) D: 30 – 45 min Incremental: 1/10th THE WEIGHT
(1 mg/mL) Maintenance: 5 – 12 µg/kg/min inf. ADR: histamine release,
bronchoconstriction etc
CIs: Avoided or low dose
administered in MG
Preg: C
Cis-atracurium Intubation: 0.2 mg/kg O: 2 – 3 min WEIGHT × 2 DIVIDED BY 10
(2 mg/mL) Incremental: 0.02 mg/kg D: 40 – 75 min No histamine release
Maintenance: 1 – 2 µg/kg/min inf. Preg: B
Rocuronium Intubation: 0.45 – 0.9 mg/kg O: 1 – 2 min ADRs: tachycardia, others
(10 mg/mL) Incremental: 0.15 mg/kg D: 30 min similar to cisatracurium
Maintenance: 5 – 12 µg/kg/min Preg: C
IM: 1 mg/kg (infant)
IM: 2 mg/kg (older child)
Vecuronium Intubation: 0.12 mg/kg O: 2 – 3 min ADRs: similar to cisatracurium
Incremental: 0.01 mg/kg D: 45 – 90 min Preg: C
Maintenance: 1 – 2 µg/kg/min
PARASYMPATHOLYTICS
 Atropine 0.01 – 0.02 mg/kg O: rapid Preg: C
(1.2mg/mL) 0.4 – 0.6 mg bolus D:
(max: 3 mg)
Glycopyrrolate 0.005 – 0.01 mg/kg O: 1 min Preg: B
(0.02 mg/mL) D: 7 hr

SYMPATHOMIMETICS / VASOPRESSORS
? Adrenaline/Epinephrine Hypotension/Bradycardia O: β1 > β2 agonist.
(10 µg/mL) 2 – 20 µg/min D: α agonist
Anaphylaxis Increased Pulm. Vascular
100 – 500 µg Resisitance
Vasopressin O: ADH receptor agonist
D: Vasoconstriction only
No effect on heart
Splanchnic vasoconstriction
Phenylephrine 0.5 – 1 µg/kg O: strong α1 agonist
(100 µg/mL) D: Causes bradycardia
Preg: C
Ephedrine 2.5 – 10 mg every 2 – 3 min O: Nonspecific α and β agonist
(5 mg/mL, 10 mg/mL) 0.1 mg/kg D: ADRs:
. Tachycardia
. Bradycardia
. PVCs
. Reactive hypertension
Preg: may cause neonatal
metabolic acidosis, otherwise
safe
Noradrenaline/ 0.1 µg/kg O: strong α1 = α2 agonist
Norepinephrine Infusion: 2 – 20 µg/min D: moderate β1 agonist
(10 µg/mL) ADRs:
Preg: C
Dopamine Low dose: 1 – 5 µg/kg/min O: Low dose:
(2.5 mg/mL, 0.5 mg/mL) D: . D agonist
. renal and mesenteric
vasodilation
. increases inotropy and
chronotropy
Medium dose: 6 – 10 µg/kg/min Medium dose:
. β1 agonist
. renal vasodilation
High dose: 11 – 20 µg/kg/min High dose:
. α1 agonist
. increases SVR
Preg: C
Dobutamine Infusion: 2 – 20 µg/kg/min O: few seconds β1 > β2 agonist
D: decreases SVR
ADRs:
 . tachyarrhythmias
(commonest)
. Hypertension
. PVCs
Preg: B
SYMPATHOLYTICS
BETA BLOCKERS
Labetalol Loading: 2.5 – 10 mg over 2 min O: 2.5 min Non selective β blocker with
(5 mg/mL) Maint.: 0.5 – 2 mg/min D: intrinsic sympathomimetic and
alpha blocking activity.
Contraindicated in asthma or
COPD.
Preg: C
Metoprolol 2 – 5 mg bolus after every 2 – 5 min O: Cardioselective β1 blocker at
(1 mg/mL) D: low dose
Preg: C
Propranolol 0.5 mg bolus every 3 – 5 min O: 2 – 10 min Non selective β blocker
(max. total: 0.15 mg/kg) D: Class II Antiarrhythmic
Esmolol Short Term Rx O: 2 – 10 min
0.2 – 0.5 mg/kg D: 10 – 30 min
Long Term Rx
0.5 mg/kg
VASODILATORS
? Nitroglycerine/Glyceryl Hypertension O: Causes reflex tachycardia.
Trinitrate/GTN Maint.: 0.5 – 10 µg/kg/min D: Preg: C
(0.2 mg/mL)
For causing Uterine Relaxation
50 – 100 µg bolus
? Na Nitroprusside Hypertension O: 1 – 2 min
Maint.: 0.5 – 10 µg/kg/min D:
Hydralazine 5 – 20 mg bolus O: 15 min
D: 2 – 4 hr
? Isosorbide dinitrate
ACLS/ANTIARRHYTHMICS
? Adrenaline/Epinephrine 1 mg bolus every 3 – 5 min O: < 1 min β1 > β2 agonist.
(10 µg/mL) D: α agonist
Preg: D during labour because
it causes uterine
vasoconstriction and foetal
anoxia. During 2nd stage of
labour it causes uterine stony
and haemorrhage. But in case
of anaphylaxis during
preggo/labour, it must be used
as first line in the same manner
as in nonpregnant people
 Vasopressin 0.01 – 0.04 units/min O: rapid ADH receptor agonist
D: 20 min Vasoconstriction only
No effect on heart
Splanchnic vasoconstriction
Amiodarone Loading: 300 mg bolus O: Preg: X
(50 mg/mL) then D:
Maint.: 150 mg every 3 – 5 min
Atropine 0.5 mg boluses O: < 1 min
(0.2 mg/mL) max. total: 3 mg D: 30 – 60 min
Adenosine 6 mg IV push then 10 mL NS push O: < 10 s Preg: C
if ineffective D: 20 – 30 s
12 mg IV push then 10 mL NS push
Lignocaine/Lidocaine 1 – 1.5 mg/kg IV stat O: 45 – 90 s Hypotension is its important
(20 mg/mL) D: 10 – 20 min adverse effect.
Preg: B
Dobutamine Infusion: 2 – 20 µg/kg/min O: β1 > β2 agonist
D: decreased SVR
MgSO4 Torsades de Pointes with pulse O: Do NOT exceed 20 g/48 hr in
(500 mg/mL) slow IV D: severe renal impairment
loading: 1 – 2 g in 50 -100 mL D5W
over 5 – 60 min
then
maint.: 0.5 – 1 g/hr
in Cardiac Arrest
slow IV
loading: 1 – 2 g in 10 mL D5W
over 5 – 20 min
ANTIDOTES/REVERSANTS
For Non Depolarizing Muscle Relaxant (NDMR) Paralysis
Neostigmine 0.04 – 0.08 mg/kg O: 1 – 20 min 1/10th THE WEIGHT HALVED
(0.41 mg/mL) D: 1 – 2 hr
For Opioid Overdose
Naloxone Adults O: Preg: C
(0.04 mg/mL) 0.5 – 1 µg/kg every 3 – 5 min D:
(max: 0.2 mg)
maint.: 4 – 5 µg/kg/hr

Neonatal Resp. Depression

10 µg/kg bolus every 2 min
For Benzodiazepine (BZD) Overdose
Flumazenil For Short Acting BZDs overdose O: Preg: C
1.1 mg/min (total: 0.6 – 10 mg) D:
repeat after 1 – 2 hr if needed

For Long Acting BZDs overdose

0.5 mg/hr
For Local Anaesthesia Associated Systemic Toxicity (LAAST)
20 % IV Lipid Infusion for < 70 kg: 1.5 mL/kg over 2 – 3 min O:
(IntraLipid®) then D:
(200 mg/mL) 0.25 mL/kg/min until 10 min after
ROSC
for > 70 kg: 100 mL bolus

For Malignant Hyperthermia (MH)

Dantrolene 1 – 2 mg/kg O: DOUBLE THE WEIGHT
(max. 10 mg/kg till effect) D:

LOCAL ANAESTHESIA
Lignocaine/Lidocaine SC: 3 – 5 mg/kg O: < 2 min for a 70 kg patient, if 2%
(20 mg/mL) D: 1 -2 hr lignocaine is being used,
MAXIMUM SC dose is full three
and a half 5 mL syringes (350
mg).
Lignocaine + Adrenaline SC: 5 – 7 mg/kg O: < 2 min - for a 70 kg patient, if 2%
(20 mg/mL + 0.1 mg/mL) D: 2 – 6 hr lignocaine + adrenaline is being
used, MAXIMUM SC dose is
about five 5 mL syringes (490
mg).
- CIed at distal sites supplied by
end arteries (nose, ears,
finger/toe tips, penis)
Bupivacaine (isobaric) SC: 1 – 2 mg/kg O:
(Bupicaine®) D:

SPINAL & EPIDURAL ANAESTHESIA

Bupivacaine (hypERbaric Intrathecal: 12 – 15 mg O: 5 min - Only for patients > 12 yr
only) Epidural: Armitage formula D: 2 – 4 hr - if 0.5 %, inject 2.5 – 3 mL
(Bupicaine Spinal®) Going cephalad: - if 0.75 % inject 1.5 – 2 mL
(5 mg/mL (0.5%) . 0.5mL for each desired lumbar
7.5 mg/mL (0.75%)) vertebra level
. 1mL for each desired thoracic
vertebra level till T6
. 1.5 ml for T4 and above

Morphine (5mg),
preservative free tramadol
(25mg),
 Fentanyl (100-200ug)
Bupivacaine , Lidocaine
Anaesthetic 0.5, 0.25%
Analgesic 0.125%

BIER BLOCK
Lignocaine 0.5 %
Upper limb
35-40mL
Lower limb
40-60 mL
DOC for Bier Block is
prilocaine

BLOOD PRODUCTS
Red Cell Concentrate (RCC) Adult: 5 mL/kg . Indicated if Hb < 7.0 g/dL
(400 mL/unit) . in adults: 1 unit RCC increases
Child: 10 - 15 mL/kg Hb by 1 g/dL in patients
without active
bleeding/haemolysis.
. in children: 10 – 15 ml/kg
increases Hb by 2 – 3 g/dL in
patients without active
bleeding/haemolysis.

Platelets (Plts) 10 mL/kg 50 mL increases Plts to 5000

(150 mL/unit) 300ml (mega unit) increases
Plts to 30000

Fresh Frozen Plasma (FFP) 15 ml/kg causes 30% correction

(150 mL/unit) 2% corrected by 1ml

Cryoprecipitate
ELECTROLYTES
Potassium Chloride (KCl) 0.5 *bw *5.2 - serum K+

Sodium Bicarbonate (NaHCO3) 0.5 *bw *base deficit

Magnesium Sulphate (MgSO4)

10 % Calcium chloride (CaCl2) HypERkalemia

3 – 5 mL
10 % Calcium gluconate HypERkalemia
 5 – 10 mL

GLUSCOSE & INSULIN

Regular Insulin Ketoacidosis In hyperkalemia, also
(Insulin R, Humulin) Adult: 10 – 20 U then 5 – 10 U/hr administer the following:
Child: 0.1 – 0.2 U/kg (max: 20 U) . salbutamol nebulization
then . CaCl2 to prevent arrhythmias
1.1 U/kg/hr (max: 5 – 10 U/hr) . NaHCO3 if acidotic
HypERkalemia . Ion exchange resin (Ca
10 U in 50 mL of 50% dextrose over Resonium) if available
30 – 60 min . dialysis/haemofiltration if
everything else fails
25 % Dextrose 1 mL increases 1 mg/dl BSR
50 % Dextrose 1 mL increases 2 mg/dL BSR
DIURETICS
Furosemide 20 mg ADRs: hypokalemia,
(Lasix®) 40 mg hyperuricemia
Max 200mg Preg: C (repeated use during
preggo may cause increased
foetal birth weight)
Mannitol 0.5 - 1g/kg Preg: C (neither animal nor
human studies done)
Hypertonic Normal Saline 3% ht saline's 2 mL raises s nacl by
(NaCl) 1mEq