# Anesthesia Drug Reference

## Benzodiazepines

### Midazolam
2ml (1mg/ml)
Typical dose: 1-2mg
Induction: 0.2-0.4mg/kg
Gtt: 0.05-0.4mg/kg/hr
Onset: 3-5min; Duration: <2hrs
Elimination: Urine

### Scopolamine
1.5mg patch
0.2-0.4mg IV (5mcg/kg) for amnesia in trauma if hemodynamically unstable

### Flumazenil
Dose: to antagonize disinhibitory reaction to benzos- 0.01 mg/kg
Onset: 1-2min, peak 6-10min; Duration: 1hr
Elimination: Hepatobiliary, Urine

### Diazepam
5mg IM
2.5mg IV

---

## Opioids
> lean body weight

### Alfentanil
5ml, 500 mcg/ml
Induction dose 20-30 mcg/kg
Infusion 0.5 mcg/kg/min, could go up to 1 mcg or even higher
Bolus: 150-250mcg
Dilute to 100mcg/ml
Take the 5cc vial which is 500mcg/cc and put all of in into 20cc saline so you have 2500mcg in 25cc or 100mcg/cc
1/10th vs 1/4th as potent as fentanyl, fastest onset time of all opioids
Onset: 1-2min; Peak: 90 seconds; Duration: 30-60min vs 10-20min?
Elimination: Urine

### Fentanyl
5ml (50mcg/ml)
Induction: 1-3mcg/kg (5mcg/kg for Neuro); LBW
Typical dose: 50-150mcg
Bolus: 25-50mcg
Onset: 1-2min; Peak 3-5min; Duration: 30min-60min
50% effect: 10-20min
Elimination: Hepatobiliary, Urine
IM: 7-15min onset, 1-2hr duration
Intranasal: 7-8min onset, 1-2hr duration

### Hydromorphone
1mg/ml
Typical dose: 0.4mg
Onset: 5-15min; Peak: 10-20min; Duration: 2-4hrs
Elimination: Urine

### Meperidine
25mg/ml
Dilute to 5mg/ml
Typical dose: 25-50mg
Onset: 5-15min; Peak: 8min?; Duration: 2-4hrs
50% effect: 1hr

### Methadone
0.1-0.3mg/kg (max 20mg)
Peak: 5-15 minutes; Duration: 6-8hrs; 24hrs?
50% effect: 1 hour

### Morphine
Typical Dose: 4-8mg IV
Onset: 5-10min; Peak: 30-90min; Duration: 3-5hrs
Elimination: Hepatobiliary, Urine

### Naloxone
RR <6 or somnolence/sedation- 0.04 MG IV, may repeat x1
Apnea or unarousable- 0.2 – 0.4 MG IV, may repeat x1
Onset: 2min; Duration: 30min-2hrs
Elimination: Urine

### Remifentanil
2mg into 40 ml = 50 mcg/ml OR 1mg into 20ml
Dilute to 50mcg/ml
Induction: 3-5mcg/kg/min (1-2min prior to intubation); LBW
Infusion: 0.05-0.2 mcg/kg/min
Bolus: 1mcg/kg; Pinning: 2-4mcg/kg (50-250mcg)
Onset: 3-5min; Peak: 90 seconds?; Duration: 5-10min

### Sufentanil
Use 50 mcg/ml, 5 ml vial
Dilution:
For 250mcg/5ml vial, dilute 250mcg into 50cc for 250/50 = 5mcg/cc
Take out 10cc for bolusing 5mcg at a time
Or can 2mL in 10mL vial = 10mcg/mL; The rest of 150 mcg dilute into 30 ml to make 5 mcg/ml
Induction: 0.1-0.3 mcg/kg
Typical dose 10-15mcg
10 mcg approximately equals 100 mcg fentanyl
Bolus: 5mcg
Maintenance: 0.1-0.5 mcg/kg/hr. Decrease by 1/2 to 1/3 over each 1/3 of case (.3/.2/.1). Turn off 15-45 minutes prior to closing.
Onset: 1-3min vs 3-5min; Duration: 5min vs 20-45min
Elimination: Urine

---

## Induction Agents

### Dexmedetomidine
2ml (100mcg/ml)
Induction: 0.5-1 mcg/kg (usually 1 mcg/kg) over 10-20 minutes
Maintenance: 0.2-1.2mcg/kg/hr
Bolus: 1 mcg/kg is standard but can cause bradycardia. Can dilute to 10 mcg/cc and start with 10 mcg boluses or 0.5 mcg/kg
Dilution: If 100 mcg/ml vial: Dilute 2cc in 50cc NS to make 4 mcg/ml solution
Onset: 5-10min; Peak 15-30; Duration: 1-2hrs
Elimination: Urine

### Etomidate
10-20ml (2mg/ml)
Typical dose: 0.2-0.3mg/kg (10-20mg); LBW
Onset: 30-60sec, peak 1min; Duration: 3-5min
Elimination: Urine

### Methohexital
0.75-1 mg/kg

### Pentobarbital
10 mg/kg over 30 minutes, 5 mg/kg/hr for 3 hours, then 1 mg/kg/hr

### Propofol
20ml (10mg/ml)
Typical dose: 1-2mg/kg IBW or LBW (150mg)
MAC: 25-75mcg/kg/min
TIVA: 100-150mcg/kg/min; TBW
Onset: 30 seconds; Duration: 3-10min
Elimination: Urine

### Thiopental
Induction: 3-5mg/kg; LBW, TBW Maintenance

---

## Neuromuscular Blockers
> ideal body weight

### Succinylcholine
10ml (20mg/ml)
Typical dose: 1-2mg/kg (100mg); TBW; Laryngospasm- 0.5mg/kg
Onset: 30 seconds- 1min; Duration: (3-5min) 5-10min
Elimination: Urine

### Rocuronium
5-10ml (10mg/ml)
Typical dose: 0.6mg/kg (40mg); ideal body weight
RSI dose: 1.2mg/kg
Defasciculating dose: 0.03mg/kg (2mg)
Onset: 1-2min; Duration: 20-35min
Metabolism: None
Elimination: Hepatic 70%, Renal 30%

### Pancuronium
Metabolism: Hepatic 10-20%
Elimination: Hepatic 15%, Renal 85%

### Vecuronium
Mix to 1mg/ml
Typical dose: 0.1-0.2mg/kg (7mg); IBW
Onset: 3-5min; Duration: 20-35min
Metabolism: Hepatic 30-40%
Elimination: Hepatic 50-60%, Renal 40-50%

### Cisatracurium
10ml (2mg/ml)
Typical dose: 0.1-0.2mg/kg
Onset: 2-3min; Duration: 30-60 minutes
Half-life: 22-25 minute
Metabolism: Hoffman 80%
Elimination: Renal 20%

---

## Reversal

### Suggammadex
2 or 5ml (100mg/ml)
Typical dose (with twitches): 2-4mg/kg (140-200mg); 16mg/kg after RSI dose

### Neostigmine
10ml (0.5mg/ml) but varies
Typical dose: 0.02-0.05mg/kg (3-5mg); max dose 0.07mg/kg or 5mg (whichever is less)
If recovery already complete, can probably use 0.015-0.02mg/kg
Onset: 10-30min; Duration: 2-4hrs
Elimination: Urine

### Glycopyrrolate
5ml (0.2mg/ml)
Typical dose: 0.008-0.01mg/kg (0.6-1mg)
*0.2mg (1mL) for each 1mg Neostigmine
**0.5-2mg for Vagolytic effect; does not cross BBB
Peds: 0.005mg/kg IV or 0.01mg/kg IM
> [Peds EZ method](https://link.springer.com/article/10.1007/s12630-022-02369-z)
>
15 minutes for full effect
Onset: 1min; Duration: peak 3hrs
Elimination: Urine and Hepatobiliary

### Atropine
1ml (0.4mg/ml)
Typical dose: 0.5mg
Peds: 0.01 mg/kg IV or 0.02 mg/kg IM
Onset: 1-4min; Duration: <4hrs
Elimination: Urine

## Analgesics

### Acetaminophen
1000mg IV or PO
Peds: 75 mg/kg PO/IV at ideal body weight in a 24 hour period

### Ketamine
Loading dose 0.5 mg/kg before incision
Induction 1-2mg/kg IV; 4-8mg/kg IM (Usually ~2mg/kg IM is sufficient, can add ~0.4mcg/kg Glycopyrrolate for secretions)
Sub-dissociative dose: 0.15-0.25 mg/kg/hr; (<30mg/hr; titrate q2-3hr)
Maintenance (Analgesia): 0.25mg/kg/hr or: 2-5mcg/kg/min
Onset: 30 sec (Oral 10-30min), Duration: 5-10min; (Oral: 40-50min), Recovery in 1-2hrs
Metabolism: Hepatic
Elimination: Urine

### Lidocaine
1-1.5mg/kg (LBW/ABW) bolus, followed by 1-2mg/kg/hr
Considerations: Narrow therapeutic window; CNS toxicity symptoms begin with tongue numbness, metallic taste, lightheadedness, tinnitus, progress to visual disturbances, twitching, unconsciousness, and seizures. CV toxicity at higher plasma level - arrhythmias, hypertension > hypotension, conduction abnormalities

### Magnesium
Infusion 6mg/kg/hr with 30mg/kg loading dose over 30-60 minutes.
Considerations: Potentiates neuromuscular blockade, can prolong emergence, can cause hypotension, bradycardia, prolonged PR or QT interval, burning/heat sensation in awake patient

## Pressors/Inotropes

### Angiotensin II
20 ng/kg/min

### Dopamine
400 mg in 250 ml = 1600 mcg/ml
Infusion: 2-20 mcg/kg/min

### Dobutamine
500mg in 250ml = 2000mcg/ml (2mg/ml)
Infuse at 2-20 mcg/kg/min

### Ephedrine
Mix to 5mg/ml
Typical dose: 5-10mg; 0.5-0.6mg/kg IM
Dilute 50mg in 10cc NS = 5mg/ml
Onset: 5-15min
Duration: 15-30min
Elimination: Urine

### Epinephrine
4 mg in 250 ml = 16 mcg/ml OR 1 mg in 250 ml = 4 mcg/ml
Mix to 10mcg/ml
Infusion: 0.02-0.3 mcg/kg/min OR 2-30mcg/min
Typical dose: 5-10mcg (1mcg/kg, 10mcg/kg in code); 100-500mcg IM
1 mcg/kg, max dose is code dose of 0.01 mg /kg
Dilute 1mg into 100cc bag = 10mcg/cc
Onset: Immediate IV, 5-10min subQ
Duration: 5min half-life
Elimination: Urine

### Isoproterenol
1mg in 250ml = 4mcg/ml
1-5mcg/min

### Milrinone
20 mg in 100 ml = 200 mcg/ml
Load 20-75 mcg/kg over 10 min
Infuse: 0.125 -0.75 mcg/kg/min

### Norepinephrine
16 mg in 250 ml = 64 mcg/ml (concentrated)
4 mg in 250 ml = 16 mcg/ml (dilute)
Infusion: 0.02 - 0.3 mcg/kg/min = 20-300 nanograms/kg/min = 2-20mcg/min
Bolus: 4-8mcg
Dilute to 4, 8, or 12.8mcg/ml(most common) poppers
Take 2ml of conc Norepi (64mcg/ml) and add to 8cc saline = 12.8mcg/ml
Onset: 1-2min
Elimination: Urine

### Phenylepherine
Mix to 100mcg/ml
10 mg in 100 ml = 100 mcg/ml
40 mg in 250 ml = 160 mcg/ml
50 mg in 250 ml = 200 mcg/ml
Infusion: 0.2-2mcg/kg/min
Typical dose: 50-100mcg; 2-5mg IM
Can also do 10 mg in 250 ml = 40 mcg/ml. 1 cc/minute, which would be 40
mcg/minute.
Onset: IV- immediate, IM-10-15min
Duration: 10-20min
Elimination: Urine

### Vasopressin
100 units in 100 ml = 1 unit/ml OR 40 units in 100ml = 0.4U/ml
Push dose: 0.5-1unit
Infusion: 0.01-0.04 units/min (no weight calc)
Dilute one 20u vial into 20ml = 1u/ml OR draw poppers directly from 0.4U/ml stock

## Antihypertensives

### Esmolol
2500 mg in 250 ml = 10 mg/ml
Infusion: 50-300 mcg/kg/min
Can load with 0.5 mg/kg over 1 minute
Bolus: 0.2-0.5 mg/kg: use around 40-60 mg for induction if heart rate is around 70-80 (Usually 20-40mg intraop)
Onset: 2-10min, Duration: 10-20min, Elimination: Urine
RBC Esterase Metabolism

### Clevidipine
25mg in 50ml = 0.5 mg/ml OR 50mg in 100ml = 0.5mg/ml
Infusion: 1-20 mg/hr
Dose may be doubled every 90 sec
Bolus: 0.05-0.1mg
0.1cc = 0.05mg
Can dilute to 0.05mg/ml (1cc in 9cc saline)
Onset: 2-4 minutes
Duration: half life 15 minutes

### Diltiazem
100 mg/100 ml = 1 mg/ml
Load 2.5 mg up to 25 mg
Then infuse 2-10 mg/hr (no weight calc)

### Hydralazine
Onset: 10-80min
Duration: Up to 12hrs
Elimination: Urine

### Labetalol
Intra-op rescue: start with 5-10mg IV; 0.2mg/kg, double dose q10min, max 300mg
Onset: 5min, peak 5-15min
Duration: 2-4hrs (16-18hrs)
Hepatic Metabolism
α:β 1:7 IV, 1:3 PO

### Mannitol
250ml 20%
0.25-1g/kg
Metoprolol
Intra-op rescue: start with 2.5-5mg IV

### Nesiritide (BNP)
1.5mg in 250ml = 6mcg/ml
Load 2mcg/kg over 1min, then infuse 0.1mcg/kg/min

### Nicardipine
25 mg in 250 ml = 0.1 mg/ml
Infusion: 1-15 mg/hr (no weight calc); Vasospasm: 0.075 – 0.15 mg/kg/hr
Bolus: 50-100mcg (up to 500mcg)
Onset: 2min, Duration: 60min
Liver metabolism; Increases contractility; Increased HR in 25%

### Nitroglycerin
50mg/100ml = 500mcg/ml OR 50 mg/250 ml = 200mcg/ml
Infusion: 5-10mcg/min up to 200mcg/min; (0.1-3mcg/kg/min)
Bolus: 50-100mcg; (1.5-2.5mcg/kg prior to laryngoscopy)
Dilute 5ml of 200mcg/ml in 20cc = 50mcg/ml or 200mcg in 10cc = 20mcg/ml
*binds to PVC tubing- use PET tubing

### Nitroprusside
50mg/100ml = 500mcg/ml OR 50 mg in 250 ml = 200 mcg/ml
Can further dilute to 25-50mcg/ml (10-20cc) or 5mcg/ml (100cc)
Infusion: 0.1-1 mcg/kg/min
Bolus: 10-20mcg; MAP decreases ~20mmHg/15mcg

### Phentolamine
For tissue extravasation
5-10 mg w/in 12 hours of extravasation
Dilute to 0.5 mg/mL then inject in multiple locations, in 1 mL increments

## Antiarrhythmics

### Adenosine
0.3-0.6 (0.5-1) mg/kg provides flow arrest of 12-50 seconds; 12mg if hypothermic (normal ACLS dose)

### Amiodarone
1200 mg in 250 ml = 4.8 mg/ml
Load 150-300 mg then infuse 1 mg/ml (no weight calc)

### Diltiazem
100mg in 100ml = 1000mcg/ml (1mg/ml)
Load 2.5mg up to 25mg, then infuse 2-10mg/hr

### Lidocaine
2 g in 250 ml = 8 mg/ml
Load 50-100 mg then infuse 1-2 mg/min ( no weight calc)
or start at 1 mg/kg/hr; check plasma levels Q8H

## PONV

### Dexamethasone
4-8mg IV at start of case
Onset:

### Ondansetron
4-8mg
Onset: 30 min
Elimination: Urine

### Prochlorperazine
10mg IV

### Promethazine
25mg IM

## Anticoagulation:

### Protamine
1mg neutralizes 100u heparin (ie. 22ml Protamine for 22ml Heparin)

## Dyes

### Fluorescein (Orange)
0.2-1cc at a time (20-100mg)
Comes as 500mg/5ml, (100mg/mL) in 5 mL vial

### Indocyanine Green (ICG)
25mg/vial, dilute in 10cc (label says 5cc) to 2.5mg/ml
Give 1-3cc bolus at a time
Max dose is 2mg/kg
Use w caution in pts w contrast allergy (contains 5% sodium iodide)

## Inhaled Medications:

### iNO (inhaled nitric oxide)
1-80 parts per million (ppm)

### Epoprostenol (Valetri)
1-2 ng/kg/min up to 80 ng/kg/min