Template:Sedative agents: Difference between revisions
(brevital) |
(Ketamine) |
||
| Line 24: | Line 24: | ||
**Wears off in 6min | **Wears off in 6min | ||
===Brevital (Methohexital)=== | ===Brevital (Methohexital)/Fentanyl=== | ||
* | *Suppresses the reticular activating center in the brainstem and cerebral cortex, thereby causing sedation | ||
*Sedation and amnesia, no analgesia | *Sedation and amnesia, no analgesia | ||
*Dose fentanyl first: 0.5-1mcg/kg | *Dose fentanyl first: 0.5-1mcg/kg | ||
| Line 31: | Line 31: | ||
*Repeat doses of 0.5mg/kg IV can be given every two minutes. | *Repeat doses of 0.5mg/kg IV can be given every two minutes. | ||
*Immediate onset, duration <10 minutes | *Immediate onset, duration <10 minutes | ||
===Ketamine=== | |||
*Noncompetitive NMDA receptor antagonist that produced dissociative state | |||
*Sedation, analgesia, and amnesia | |||
*Maintain upper airway tone, protective reflexes, spontaneous breathing | |||
*May pretreat with 0.05 mg/kg prior to prevent emergency reaction | |||
*1 mg/kg IV, followed by 0.5-1 mg/kg IV PRN | |||
*4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful | |||
*Duration 10 to 20 minutes | |||
===Propofol/Ketamine (Ketofol)=== | ===Propofol/Ketamine (Ketofol)=== | ||
Revision as of 21:10, 28 October 2015
Sedative agents
- Propofol
- Opioids
- Benzodiazepines
- Dexmedetomidine
- Ketamine
- Haloperidol and other tranquilizers
Fentanyl/Versed
- Designed for moderate sedation
- If titrate to deep sedation, when painful stimulus stops may become apneic
- Duration = 30min
Etomidate/Fentanyl
- Similar to versed/fentanyl but better b/c of shorter duration of action
- Good for brief sedation if don't have access to propofol
- E.g. shoulder/hip reduction, cardioversion
- Dose fentanyl first: 0.5-1mcg/kg
- Etomidate 0.15mg/kg (8-10mg avg)
- Wears off in 6min
Brevital (Methohexital)/Fentanyl
- Suppresses the reticular activating center in the brainstem and cerebral cortex, thereby causing sedation
- Sedation and amnesia, no analgesia
- Dose fentanyl first: 0.5-1mcg/kg
- Initial dose 0.75 to 1mg/kg IV
- Repeat doses of 0.5mg/kg IV can be given every two minutes.
- Immediate onset, duration <10 minutes
Ketamine
- Noncompetitive NMDA receptor antagonist that produced dissociative state
- Sedation, analgesia, and amnesia
- Maintain upper airway tone, protective reflexes, spontaneous breathing
- May pretreat with 0.05 mg/kg prior to prevent emergency reaction
- 1 mg/kg IV, followed by 0.5-1 mg/kg IV PRN
- 4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful
- Duration 10 to 20 minutes
Propofol/Ketamine (Ketofol)
- 1:1 mixture of ketamine and propofol[1]
- Theorized that side-effect profiles counter one another
- Dose: 0.5mg/kg propofol with 0.5mg/kg ketamine (may be mixed in same syringe)
- ↑ Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952