Template:Sedative agents: Difference between revisions
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*Sedation, analgesia, and amnesia | *Sedation, analgesia, and amnesia | ||
*Maintain upper airway tone, protective reflexes, spontaneous breathing | *Maintain upper airway tone, protective reflexes, spontaneous breathing | ||
* | *To prevent emergence delerium, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)<ref>Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2</ref> | ||
*1 mg/kg IV, followed by 0.5-1 mg/kg IV PRN | *1-2 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 | *4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful | ||
*Duration 10 to 20 minutes | *Duration 10 to 20 minutes | ||
Revision as of 21:53, 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
- To prevent emergence delerium, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)[1]
- 1-2 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[2]
- Theorized that side-effect profiles counter one another
- Dose: 0.5mg/kg propofol with 0.5mg/kg ketamine (may be mixed in same syringe)
- ↑ Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2
- ↑ 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