DEPARTEMEN ANESTESI

FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN

UNIVERSITAS MUHAMMADIYAH MAKASSAR

Jurnal Reading
Anesthethic Drugs :
A Comprehensive Overview For
Anesthesiologist
Pembimbing :dr. Zulfikar Tahir. M.Kes, Sp. An-TI
Pipit Fitriyanti (105501107721)
Kholifah Wirdayana Dahlan (105501107621)
Khalidinah Iriansyah (105505419817)
 INTRODUCTION
This paper is a unique document as it is unlike other papers whose main focus is on expanding
knowledge or summarizing it, whereas the purpose of this document is to use of different anesthetic
drugs and the key clinical pearls for ensuring patient safety.

The hope of the authorial team is to create a centralized document that gets updated and edited as
necessary with the potential for growth and modification based on the information as it becomes
available. This first, improves patient safety; second, ease in teaching and educating on the topic of
the different and numerous anesthetic drugs is increased; and third, providers feel more comfortable
with utilizing a more diverse array of medications to treat the specific individualized needs of the
patients.
Opioid/Narcotic Anesthetics

FENTANYL : an opioid pain medication used to

treat acute, severe, or chronic pain.

USAGE : Fentanyl is an incredibly versatile

anesthetic drug that is used preoperatively, during
surgery, and in immediate postoperative periods.
DOSIS :
 The typical preoperative dosage should be 50-100mcg/dose IM or slow IV over 30-60 minutes prior to
surgery where adjunct to regional anesthesia should be 25-100mcg/dose slow IV over 1-2 minutes
 For minor surgical procedures, a dosage of 0.5-2mcg/kg/dose IV should be used, whereas for a major
surgery, the proper dosage should be 2-20mcg/kg/dose initially with maintenance 1-2mcg/kg/hr IV
 Infusion should be discontinued 30-60 minutes prior to the end of surgery and adjunct to general
anesthesia, although rare, should be 20-50mcg/kg/dose IV.
 The total doses should not exceed 10-15 mcg/kg for fast tracking and early extubation.
 In children greater than 12-years-old, 0.5-1.0mcg/kg/dose IV should be given every 1-2 hours as
needed.
 In children 1-12-years-old, a dose of 1-4mcg/kg/dose IV should be given every 2-4 hours as needed.
 Common interactants may include, but are not limited to any drugs that cause
MAJOR INTERACTIONS : sleepiness or slow breathing such as opioids, sleeping pills, muscle relaxers, or
medication for anxiety or seizures.

SIDE EFFECTS : Respiratory depression, blurred vision, chest pain, unsual tiredness or weakness

NAME BRANDS : Duragesic, Fentanyl Transdermal System, Sublimaze, Ionsys, Lazanda, and Fentora
Opioid/Narcotic Anesthetics

REMIFENTANYL : an opioid medication that is

used to treat and/or prevent pain during and after
surgery or other medical procedures.

USAGE : Remifentanil is most widely used in

patients that require or have recently undergone a
surgery or another medical procedure
DOSIS :

 If given through intubation, the induction of anesthesia should be 0.5-1mcg/kg/minute by continuous

IV infusion.
 An initial dose of 1mcg/kg over 30-60 seconds may be administered as well. With nitrous oxide at
66%, the maintenance of anesthesia should be a continuous IV infusion at 0.4mcg/kg/min.
 During post-op, continuous IV infusion should be used at 0.1mcg/kg/min with every 5 minutes being
adjusted in 0.025mcg/kg/min increments, where the maximum rate is 0.2mcg/kg/min.
 For a child 1-12 years of age, the initial dose should be 1mcg/ kg IV over 30-60 seconds, where
maintenance dosing should be 1mcg/kg every 2-5 minutes.
 Common interactants may include, but are not limited to any drugs that cause
MAJOR INTERACTIONS : sleepiness or slow breathing such as opioids, sleeping pills, muscle relaxers, or
medication for anxiety or seizures.

Respiratory depression, blurred vision, quick onset bradycardia, chest pain, unsual
SIDE EFFECTS : tiredness or weakness

NAME BRANDS : Ultiva

Opioid/Narcotic Anesthetics

HYDROMORPHONE : an oral opioid

medication that is seven times more potent than
morphine used to treat moderate to severe pain.

USAGE : Short-acting formulations of

hydromorphone are used to treat moderate to
severe pain whereas extended-release
hydromorphone is used as an around-the-clock
treatment for pain management.
DOSIS :
 Oral solution should be used at 2.5-10ml every 3-6 hours as needed for pain.
 If using tablet form, 2-4mg should be taken orally every 4-6 hours.
 In pediatric patients, the typical dosing is 0.03-0.08mg/kg/dose orally every 4-6 hours or
0.01mg/kg/dose IV every 4-6 hours.

Common interactants may include, but are not limited to any drugs that cause
MAJOR INTERACTIONS : sleepiness or slow breathing such as opioids, sleeping pills, muscle relaxers, or
medication for anxiety or seizures.

SIDE EFFECTS : Respiratory depression, blurred vision, chest pain, unsual tiredness or weakness

NAME BRANDS : Dilaudid, Dilaudid-5, Exalgo, and Palladone

 Inhaled Anesthetic Agents
DESFLURANE : This drug is administered
through inhalation, and the mechanism of action is
believed to be on the GABA receptor, thus acting
on the lipid matrix of the neuronal membrane that
leads to the disruption of neuronal transmission to
the brain.

USAGE : Desflurane can be used by inhalation to

cause loss of consciousness both before and after
surgery in adults.
DOSIS :

 Although the below values are considered the normal accepted minimum alveolar concentrations
(MAC), each should be adjusted as needed based on the patient’s age, comorbidities, additional
medications, and substance use history.
 For inhalation in adult patients, the minimum alveolar concentration, or MAC, for which 50% of
patients do not respond to surgical incision ranges from 7.3%, for 25-yearolds, to 6%, for 45-year-olds.
The concentration at which loss of awareness and amnesia occur is 2.4%, and surgical levels of
anesthesia are achieved with consciousness between 2.5-8.5% with or without nitrous oxide.
 For geriatric patients, the typical MAC is reduced to 5.2% for 70-year-olds, where amnesia and loss of
awareness occurs at 2.4%, and surgical levels are achieved at 2.5-8.5% with or without nitrous oxide.
 In pediatric patients, the MAC should be highly individualized, however, the surgical levels of
anesthesia will increase to 5.210% with or without nitrous oxide.
 Droperidol can increase the risk of an irregular heart rhythm that may be serious or
potentially life-threatening, although rare, when used with desflurane. Individuals with
MAJOR INTERACTIONS : congenital long QT syndrome or other cardiac diseases, conduction abnormalities, or
electrolyte disturbances may be more susceptible.

SIDE EFFECTS : Blush lips or skin, respiratory depression, difficulty swallowing, tightness of the chest

NAME BRANDS : Suprane

 Inhaled Anesthetic Agents
ISOFLURANE : a general liquid, inhalation
anesthesia administered by vaporizing, and while
the mechanism of action is not fully established, it
is believed to act on the lipid matrix of the
neuronal membrane that leads to the disruption of
neuronal transmission to the brain.

USAGE : Isoflurane is used for the induction and

maintenance of general anesthesia.
DOSIS :
 Although the below values are considered the normal accepted minimum alveolar concentrations
(MAC), each should be adjusted as needed based on the patient’s age, comorbidities, additional
medications, and substance use history.
 The typical dose for an adult or pediatric patient should be inspired concentrations of 1.5-3.0% to
produce surgical anesthesia within 7-10 minutes. To sustain surgical anesthesia, a concentration of 1.0-
2.5% should be used with nitrous oxide, whereas 0.5-1.0% may be required when using oxygen alone.
Droperidol can increase the risk of an irregular heart rhythm that may be serious or
potentially life-threatening, although rare, when used with isoflurane. Individuals with
MAJOR INTERACTIONS : congenital long QT syndrome or other cardiac diseases, conduction abnormalities, or
electrolyte disturbances may be more susceptible.

Signs of high potassium levels, malignant hyperthermia, tavhycardia, shortness of

SIDE EFFECTS : breath, respiratory depression

NAME BRANDS : Forane and Terrell

 Inhaled Anesthetic Agents

SEVOFLURANE : an inhaled general anesthetic

used to cause loss of consciousness postoperatively
and during surgery or any other medical procedure.

USAGE : Sevoflurane is given to patients before

and during surgeries or other medical procedures
to cause loss of consciousness and loss of
awareness.
DOSIS :
 Although the below values are considered the normal accepted minimum alveolar concentrations
(MAC), each should be adjusted as needed based on the patient’s age, comorbidities, additional
medications, and substance use history.
 The average MAC for surgical anesthesia with oxygen is 2.6% in a 25-year-old, 2.1% in a 40-year-old,
and 1.7% in a 60-yearold.
 The average MAC for surgical anesthesia with 65% nitrous oxide is 1.4% in a 25-year-old, 1.1% in a
40-year-old, and 0.9% in a 60-year-old.
 For geriatric patients, the average MAC for surgical anesthesia is 1.4% and 0.7% in an 80-year-old
with oxygen and 65% nitrous oxide, respectively.
 In pediatric patients, the average MAC for surgical anesthesia in oxygen is 3.3% in a 0-1-month-old,
3% in a 1-6-month-old, 2.8% in a 6-month-3-year-old, and 2.5% in a 3-12-year-old.
 The average pediatric MAC for surgical anesthesia with 60% nitrous oxide is 2% in a 6-month-3-year-
old.
 Medication such as sevoflurane could potentially interact with many other drugs and
cause dangerous side effects, or even death. Epinephrine and norepinephrine can be
MAJOR INTERACTIONS : used to correct life-threatening hypotension or cardiac failure. CNS depressants
should be avoided for 24 hours after receiving inhaled anesthetics.

SIDE EFFECTS : Nausea, chills, dizziness, increased saliva, drowsiness, headaches, or vomiting.

NAME BRANDS : Sojourn and Ultane

 Intravenous Anesthetic Agents

Etomidate : a sedative and hypnotic agent that is used

for general anesthesia by enhancing the inhibitory
effect of GABA on the CNS.

USAGE : This anesthetic is useful in patients with

compromised cardiopulmonary function due to the
minimal hemodynamic effects and decreased
respiratory depressant effects relative to other IV
anesthetics such as barbiturates and propofol.
DOSIS :
 For both typical adult and pediatric patients, the introduction of anesthesia by IV should be 0.2-
0.6mg/kg with an average of 0.3mg/kg from a 0.2% solution. For maintenance of etomidate by IV,
smaller increments than the original dose should be used; typically doses of 0.05-0.1mg/kg are used as
needed with an average total dosage of up to 0.26mg/kg
 For geriatric patients, the dosage should be lower than younger patients due to their pharmacokinetic
differences.

- Isocarboxazid, phenelzine, selegiline, or tranylcypromine may significantly affect

blood pressure if used alongside etomidate.
MAJOR INTERACTIONS :
- Sodium oxybate

SIDE EFFECTS : Neusea/ vomiting, skeletal muscle movement.

NAME BRANDS : Amidate

 Intravenous Anesthetic Agents

Ketamine :an injectable anesthetic solution used in

surgeries and to prevent pain.

USAGE : Ketamine is used preoperatively and during

surgeries as well as being widely used to prevent pain
and discomfort during certain medical procedures.
DOSIS :
 In adults, induction should be 1.0-4.5mg/kg IV with an average of 1.5mg/kg or 1.0-2.0mg/kg IV at a
rate of 0.5mg/kg/min.
 If by IM, induction should be 6.5-13.0mg/kg, where 9-13mg/ kg IM provides 12-25 minutes of surgical
anesthesia. For maintenance, dosage should be adjusted according to the patient’s anesthetic needs

Total list of 197 interactants should be reviewed, Any drugs that cause sleepiness or
MAJOR INTERACTIONS : slow breathing

Blood in urine, Painful urination, Insomnia, Nausea/vomiting, Incontinence,

SIDE EFFECTS : Bradycardia, Extreme fear

NAME BRANDS : Ketalar

 Intravenous Anesthetic Agents

Methohexital : an injectable anesthetic that slows the

activity of the brain and nervous system through the
binding to the GABA-A/chloride ionophore receptor
complex.

USAGE : Methohexital is used to cause patients to

fall asleep preoperatively or for any other medical
procedure.
DOSIS :
 Induction for a typical adult should be 1.0-1.5mg/kg of a 1% solution IV at a rate of 1ml/5 seconds,
which usually lasts 5-7 minutes. Intermittent IV injections of 20-40mg of the 1% solution every 4-7
minutes or administration of 3ml of 0.2% solution IV every minute.
 For pediatric patients one month or older, induction should be IM 6.6-10mg/kg with a 5% solution or
rectal 25mg/kg using a 1% solution.

Anisindione, dicumarol, or warfarin. Ethanol, Hemin, Isocarboxazid, phenelzine,

MAJOR INTERACTIONS : selegiline, or tranylcypromine. Sodium oxybate

Tachycardia, Shallow breathing, Anxiety, Nausea/vomiting, Chills, Lightheadedness,

SIDE EFFECTS : Muscle twitching, Hiccups

NAME BRANDS : Brevital Sodium

 Intravenous Anesthetic Agents

Propofol : an anesthetic drug used to slow the activity

of the brain and nervous system by decreasing the rate
of dissociation of the GABA from the receptor,
resulting in hyperpolarization of cell membranes.

USAGE : preoperatively to place patients into sleep

as well as to keep them unconscious during general
anesthesia for surgery or other medical procedures.
Additionally, this drug is used to sedate patients who
are under critical care and require a mechanical
ventilator
DOSIS :
 The induction dosage for a typical adult less than 55-years-old should be 2-2.5mg/kg IV, titrated at
roughly 40mg/10 seconds until onset of induction.
 For cardiac anesthesia or neurosurgical patients, 20mg/10 seconds should be used. For maintenance of
a typical adult less than 55-years-old, 100-200mcg/kg/min IV with 60-70% nitrous oxide should be
used.
 The induction for a pediatric patient between the ages of 3-16 should be 2.5-3.5mg/kg over 20-30
seconds. To maintain, 200-300mcg/kg/min should immediately follow the induction dose, where the
first 30 minutes of maintenance should have an infusion rate of 125-150mcg/kg/min.
 Isocarboxazid, phenelzine, selegiline, or tranylcypromine. Sodium oxybate. Oliceridine
MAJOR INTERACTIONS : or remimazolam. Ozanimod or papaverine

Propofol infusion syndrome, Bradycardia, Tachycardia, Shallow breathing,

SIDE EFFECTS : Lightheadedness, Rash

NAME BRANDS : Diprivan and Propoven

 Neuromuscular Bloking Agent (Regional)
Anasthetic
Cisatracurium : an anesthetic used to relax muscles
by blocking cholinergic receptors leading to the
blockage of neuromuscular transmission.

USAGE : Cisatracurium is typically given before

general anesthesia in preparing a patient for surgery as
to keep them still during the procedure. Cisatracurium
should only be used by trained providers and should
only be used on patients with a secured airway.
DOSIS :
 For adults and children older than 12-years-old, induction dose should be 0.15-0.2 mg/kg IV with
additional maintenance dosage of 0.03 mg/kg to be used after 40-65 minutes.
 Continuous infusion should be 1-3 mcg/kg/min. In pediatric patients 2-12-years-old, induction dose
should be 0.1-0.15 mg/ kg IV with continuous infusion of 1-3 mcg/kg/min.
 In pediatric patients 1-23-months-old, induction dose should be 0.15 mg/kg.

MAJOR INTERACTIONS : Lithium, Antibiotics, Seizure medications

SIDE EFFECTS : Paralysis, Respiratory arrest, Bradycardia, Dizziness

NAME BRANDS : Nimbex

 Neuromuscular Bloking Agent (Regional)
Anasthetic
Rocuronium : an anesthetic used to relax muscles by
blocking the signals through the action as an
aminosteroid non-depolarizing neuromuscular
blocker.

USAGE : Rocuronium should only be used by trained

providers and should only be used on patients with a
secured airway.
DOSIS :
 For an adult patient, the initial dosage prior to intubation should be 0.6mg/kg IV with maintenance
doses of 0.1, 0.15, and 0.2mg/kg.
 Continous infusion should be at a rate of 10-12mcg/kg/min. For a pediatric patient, the initial dosage
prior to intubation should be 0.45-0.6mg/kg IV

MAJOR INTERACTIONS : Lithium, Quinidine, Procainamide, Antibiotics, Seizure medications

SIDE EFFECTS : Paralysis, Respiratory arrest, Hypertension, Anxiety, Blurred vision

NAME BRANDS : Zemuron

 Neuromuscular Bloking Agent (Regional)
Anasthetic
Succinylcholine : depolarizing neuromuscular
blocking agent that works by binding to the nicotinic
receptors at the neuromuscular junction.

USAGE : Succinylcholine is used for skeletal muscle

relaxation for short durations during medical
procedures after general anesthesiahas been induced.
Additionally, it is used for the facilitation of intubation
to relax the muscles in the throat.
DOSIS :
 For short surgical procedures in adult patients, a dosage of 0.3-1.1mg/kg IV should be used, whereas
for long surgical procedures in adult patients, a dosage of 2.5-4.3mg/min IV should be used.
 For short surgical procedures in pediatric patients, a dosage of 0.3-1.1mg/kg should be used over 10-30
seconds, whereas for long surgical procedures in pediatric patients, a dosage of 2.5- 4.3mg/minute IV
should be used

MAJOR INTERACTIONS : Oxytocin, Lithium, MAO inhibitors, Corticosteroids, Procaine

SIDE EFFECTS : Paralysis, Respiratory arrest, Hyperkalemia, Hypertension, Hypotension

NAME BRANDS : Anectine and Quelicin

 Neuromuscular Bloking Agent (Regional)
Anasthetic
Vecuronium : an anesthetic which relaxes muscles by
competitively binding to the nicotinic acetylcholine
receptor at the neuromuscular junction, preventing
acetylcholine to bind and resulting in muscle
relaxation.

USAGE : is used for skeletal muscle relaxation for

short durations during medical procedures after
general anesthesia has been induced.
DOSIS :
 For adult patients, the initial dose should be 0.08-0.1mg/kg IV, where the maintenance dose during
prolonged surgical procedures should be 0.01-0.015mg/kg for 25-40 minutes after and as frequent as
every 12-15 minutes.
 For continuous infusion in an adult patient, an intubating dose should be 80-100mcg/kg followed by
20-40 minutes later with 1mcg/kg/min

Medication such as vecuronium could potentially interact with many other drugs and
MAJOR INTERACTIONS : cause dangerous side effects, or even death.

Paralysis, Respiratory arrest, Muscle weakness, Loss of bodily movements, Shallow

SIDE EFFECTS : breathing

NAME BRANDS : Vecuronium bromide and Norcuron

 Benzodiazepine Anesthetic
Midazolam : Midazolam an oral anesthetic
medication used for sedation that is five times more
potent than diazepam.

USAGE : Midazolam is used to sedate patients who

are having minor surgeries, dental work, or other
specific medical produceres.
 DOSAGE

For light sedation in a typical adult under In pediatric patients, the recommended
60 years, 0.07-0.08mg/kg IM oral dose should be 0.25-0.5mg/kg/dose

If given by IV, 1.0-2.5mg every 2 minutes If administering midazolam by IV, the

should be used with a maintenance dose recommended dose for a pediatric patient
of 25% should be 0.025-0.1mg/kg/dose

For light anesthesia in a premedicated

If administering midazolam intranasally,
typical adult patient, 0.25mg/kg IV
the recommended pediatric dose is 0.2-
0.3mg/kg/dose
 Total list of 34 major interactants should be reviewed, Any drugs that cause sleepiness
MAJOR INTERACTIONS : or slow breathing

Decreased ability to swallow, Insomnia, Nausea/vomiting, Pale/blue lips, skin, or

SIDE EFFECTS : fingernails. Irregular heartbeat, Shakiness.
Drug Name Adult Dosing Major Major Side
Interactans Effects
Cisatracurium Induction 0,15- Lithium Paralysis
Systemic 0,2mg/kg/IV Antibiotics Respiratory
Maintenance Seizures arrest
0.03mg/kg every medications Bradicardia
40-65mins Dizzines
Desflurane MAC for 25-45 Droperidol
Systemic year olds ranges Epinephrine or
from 7.3-6% norepinephrine
respectively Isocarboxazid,
phenelzine
 CONCLUSION

The purpose of this paper is to provide a

clear and easy means to navigate a
document on the use of different
anesthetic drugs and the key information
into a singular document, this paper can
be utilized as a convenient guide in work
rooms for residents and medical school
trainees.
 THANKS!

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