Template:Sedative agents

Sedative agents

• Propofol
• Opioids
  • Fentanyl
  • Morphine
• Benzodiazepines
  • Midazolam
  • Lorazepam
• 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
• Theorized that side-effect profiles counter one another
• Dose: 0.5mg/kg propofol with 0.5mg/kg ketamine (may be mixed in same syringe)