TABLE 1 ANESTHETICS / PARALYTICS (S.

Kache, MD)
MEDICATION INTERMITTENT CONTINOUS ONSET OF DURATION ADVANTAGES DISADVANTAGES REVERSAL
DOSING INFUSTION ACTION OF ACTION AGENT
Analgesics
Morphine 0.05mg0.2mg/kg 0.02-0.3mg/kg/hr 5 15 min 2 6 hours Long acting Cases histamine release Narcan
every 1-4 hours analgesic with worsening any
pain control reactive airway disease
lasting 1-4 and may cause profound
hours itching
Longer effect with
prolonged depressed
mental status frequent
neurologic evaluations
may be difficult
Respiratory depression
Hemodynamic instability
Build-up of drug /
metabolite in hepatic
insufficiency or renal
failure patients
amplifying respiratory
depression and
hemodynamic instability

Fentanyl 1mcg 3mcg/kg every 0.5 5mcg/kg/hr 1 5 minutes 30 90 minutes Short acting Rigid chest: chest Narcan
0.5-2 hours allowing for muscle rigidity which
frequent occurs with rapid push
neurologic of IV fentanyl and can
assessments in only be treated with
patients with paralytics
CNS pathology Short acting pain
Decreased control provided for
hemodynamic shorter period
instability as
compared to
morphine

Dilaudid 15 mcg/kg every 2-6 1 10mcg/kg/hr 15 30 minutes 15 30 minutes Excellent pain Cases histamine release Narcan
hours control for worsening any
patients with reactive airway disease
chronic pain Longer effect with
prolonged depressed
mental status frequent
neurologic evaluations
may be difficult
Respiratory depression
Increases ICP not to
be used in patients with
intracranial lesions

Sedation Chart 1
MEDICATION INTERMITTENT CONTINOUS ONSET OF DURATION ADVANTAGES DISADVANTAGES REVERSAL
DOSING INFUSTION ACTION OF ACTION AGENT
Sedatives
Versed 0.05mg 0.2mg/kg 0.02 0.3mg/kg/hr 1 2 minutes 30 80 minutes Short acting Hypotension should be Flumazenil
every 0.5-2 hours (max sedative lasting used cautiously in
dose 4mg) 20-30min with patients with depressed
intermittent cardiac function
dosing Respiratory depression
Hepatic clearance;
prolonged hemodynamic
and neurologic
depressive effects in
patients with hepatic
failure

Ativan 0.05mg 0.2mg/kg Not recommended 5 15 minutes 6 8 hours Longer acting Hypotension should be Flumazenil
every 1-4 hours (max due to build-up of sedative used cautiously in
dose 4mg) carrier patients with depressed
cardiac function
Respiratory depression
Hepatic clearance;
prolonged hemodynamic
an respiratory
depressive effects in
patients with hepatic
failure

Propofol 1mg 5mg/kg bolus 20 250 10 50 seconds 3 10 minutes Rapid onset of Hypotension by
dosing mcg/kg/min (with bolus (with bolus action makes it decreasing both cardiac
dosing) dosing) an ideal drug output and systemic
for procedural vascular resistance;
sedation should be used with
Decreases ICP extreme caution in
(intra-cranial patients with depressed
pressure) and cardiac function
cerebral Depresses respiratory
metabolism drive
maybe ideal in Not approved for
patients with prolonged infusions in
CNS pathology pediatric patients

Dexmetomidine None 0.2 1.5mcg/kg/hr Provides Often associated with

sedation bradycardia and
without secondary hypotension
respiratory Cleared by liver &
depression kidney; ? buildup with
Pain control hepatic or kidney failure
lasting 1-4
hours

Sedation Chart 2
MEDICATION INTERMITTENT CONTINOUS ONSET OF DURATION ADVANTAGES DISADVANTAGES REVERSAL
DOSING INFUSTION ACTION OF ACTION AGENT
Anesthetics
Ketamine 1mg 2mg/kg IV or 3 10 50mcg/kg/min 30 seconds 5 15 minutes Provides both A relative contra-
5 mg/kg IM sedation and indication in patients
analgesia with increased intra-
Rapid onset of cranial pressure due to
action ideal increase in blood
for procedural pressures
sedation Dissociative anesthetic
Usually causes with visual hallucinations
a rise in blood not well tolerated by
pressure patients usually with
ideal for developmental age of 8
patients with years or older; therefore
depressed a benzodiazepine must
cardiac often be concurrently
function administered
Improves Increases oral and
reactive airway airway secretions; an
disease ideal anti-sialogogue such as
to sedate glycopyrrolate should be
asthmatic co-administered
patients
No depression
of respiratory
drive

Etomidate 0.3mg/kg Not recommended 10 20 seconds 4 10 minutes Does not cause Causes adrenal
hypotension suppression, perhaps
ideal choice for even with single dosing;
patients with multiple doses not
poor cardiac recommended
output Causes histimine release
Does not worsening any
increase ICP reactive airway disease
ideal for
patients with
CNS pathology

Sedation Chart 3
MEDICATION INTERMITTENT CONTINOUS ONSET OF DURATION ADVANTAGES DISADVANTAGES REVERSAL
DOSING INFUSTION ACTION OF ACTION AGENT
Anesthetics
Paralytics
Succinylcholine 2mg/kg Not Recommended 30 60 seconds 6 10 minutes Rapid onset of Can cause hyperkalemia
action: 30 60 in burn and crush injury
seconds patients
Duration of Malignant hyperthermia
action: 6-10 in at prone patients
minutes

Rocuronium 1-2 mg/kg Not Recommended 1 2 minutes 10 30 minutes Rapid onset of

action: 1-2
minutes

Vecuronium 0.1-0.2 mg/kg 0.05-0.3mg/kg/hr 2 4 minutes 30 40 minutes Prolonged Can cause

titrated to effect as paralysis polyneuropathy when
based on patient used in patients for
movement and train prolonged periods
of 4 Hepatic clearance: must
be used with question in
patients with liver
failure

Sedation Chart 4