Adult Drug Doses
- Pre-Induction & Induction
- Muscle Relaxants
- Inhalational Anesthetics
- Vasopressors
- Anti-Hypertensives
- Common Infusions
- Hyperglycemia Insulin Protocol
- Antibiotics
- Other Medications
Pre-Induction & Induction
| Medication | Induction Dose | Duration | Comment |
|---|---|---|---|
| Thiopental | 2.5-5 mg/kg, over 15 sec | 60 min | Decreases systolic BP, SVR, CO; respiratory depression |
| Fentanyl | 50- 250 mcg | 30-60 min | Onset 1-3 min; blunts hemodynamic response to laryngoscopy |
| Ketamine | 1-2 mg/kg IV | 15-30 min | Dissociation, treats pain and hypnosis; maintains ventilation; salivation; releases catecholamines |
| Lidocaine | 1 mg/kg | 90-120 min | Blunts hemodynamic response to laryngoscopy; eases Propofol “burn”; anti-inflammatory, helps with pain |
| Midazolam | 1-2 mg pre op | 2-6 h | Avoid in elderly; for anterograde amnesia |
| Propofol | 1-2.5 mg/kg | 5-10 min | Hypnotic, provides unconsciousness; “burns” in IV; decrease SVR |
Muscle Relaxants
| Medication | Induction Dose | Duration (Onset) | Comment |
|---|---|---|---|
| Rocuronium | 0.6-1.2 mg/kg | 55-80 min (1-2 min) | RSI dose 0.9-1.2 mg/kg |
| Suxamethonium | 1-2 mg/kg | 10-12 min (30 sec) | Avoid in hyperkalemia; quick onset (good for RSI); muscle fasciculations |
| Vecuronium | 0.1 mg/kg | 50-80 min (2-3 min) | Takes 3 minutes to take effect |
| Cisatracurium | 0.15 mg/kg | 60-90 min (3-4 min) | Hoffman degradation |
| Atracurium | 0.5 mg/kg | 30-45 min (3-5 min) | Hoffman degradation; histamine release |
Reversal Agents
| Medication | Induction Dose | Comment |
|---|---|---|
| Neostigmine | 0.05-0.07 mg/kg (max dose 5 mg total) | Full reversal effect takes 15 minutes; need at least 1 twitch to give; must pair with antimuscarinic (Glyco, Atropine) to avoid bradycardia, bronchospasm, etc |
Inhalational Anesthetics
| Medication | MAC (Minimum Alveolar Concentration) | Comment |
|---|---|---|
| Halothane | 0.76% | Decreases myocardial contractility (can lead to bradycardia or asystole); less pungent, can use for inhalational induction; risk of hepatotoxicity |
| Isoflurane | 1.2% | May take longer to wear off after 2-4 hours of use; pungent; coronary steal |
| Nitrous Oxide | 104% | Avoid in air embolism, PTX, bowel obstruction, pulmonary HTN, high ICP; activity at NMDA-R; less vasodilating than other gases |
| Sevoflurane | 1.85% | Least pungent, good for inhalational inductions (ex. Pediatrics); theoretical risk of Compound A formation |
- Age-adjusted MAC: Subtract 6-10% for every 10 years after 40
- MAC-Aware: 0.3-0.5 MAC
- MAC-Bar: 1.5-2.0 MAC
- MAC-Awake: 0.15-0.5 MAC
Vasopressors
| Medication | MOA | Effect | Bolus Dose | Comment |
|---|---|---|---|---|
| Phenylephrine (Neosynephrine) | Pure \alpha 1 | Vasoconstricts | 50 - 200 mcg | Reflex bradycardia |
| Ephedrine | alpha-1 > beta-1 | Increase contractility, HR, vasoconstricts | 5 – 10 mg | Stimulates release of norepinephrine; tachyphylaxis |
| Norepinephrine/Noradrenaline (Levophed) | alpha-1 > beta-1 | Increase contractility, HR; vasoconstricts | 3 – 6 mcg | Vasopressor of choice in sepsis |
| Epinephrine/Adrenaline | Alpha-1,2 Beta-1,2 | Increase contractility, HR; vasoconstricts | “Baby Epi” 5 – 10 mcg | Also Bronchodilator |
| Vasopressin | V1 vascular receptor | Vasoconstricts | 0.5 - 1 unit | Effective for hypotension from ACEi and ARBs |
Anti-Hypertensives
| Medication | MOA | Bolus Dose | Duration (Onset) | Comment |
|---|---|---|---|---|
| Esmolol | beta-1 selective blocker | 10-30 mg | 10-30 min (1 min) | esterase degradation |
| Metoprolol | 5 mg | 6 hours (5-20 min) | ||
| Labetalol | A1 < B1 = B2 antagonist | 5-10 mg | 6 hours (2-5 min) | Alpha:beta blockade is 1:7 |
| Nitroglycerin | Venous > arterial dilation, coronary vasodilator | 10-50 mcg | 3-5 min (1-2 min) | Dilute 1 cc in 9 cc of saline to make 0.5 mg/ml. Then dilute 1 cc of that into 9 cc of saline to make 50 mcg/ml |
| Nitroprusside | Arterial > venous dilation | 10-50 mcg | 10 min (1 min) | risk of cyanide toxicity |
| Hydralazine | Arterial vasodilator | 5-10 mg | 6-12h (5-15 min) | rebound tachycardia; headache, less predictable |
Common Infusions
| Drug | Rate | Loading Dose | Comment |
|---|---|---|---|
| Amiodarone | 0.5-1 mg/min | 150 mg over 10 min | Can be given through peripheral up to 3 mg/mL |
| Dobutamine | 2.5-15 mcg/kg/min | none | |
| Dopamine | 2-20 mcg/kg/min | none | Central line preferred! |
| Epinephrine | 0.5-100 mcg/min | none | Central line recommended |
| Fentanyl | 25-300 mcg/hr | none | Accumulates (context sens half time) |
| Insulin | 1-15 Units/hr | 0.1 units/kg | Dose depends on BS. Recheck BS q1h while on drip |
| Ketamine | 2-5 mcg/kg/min 0.3mg/kg/hr | 0.5 mg/kg bolus | If >65 yo, may reduce infusion to 0.25 mg/kg or avoid bolus. |
| Lidocaine | 1-4 mg/min | 1-1.5 mg/kg | Caution with hepatic impairment |
| Nitroglycerin | 5-40 mcg/min | none | May see tachyphylaxis with extended use; avoid with elevated ICP |
| Nitroprusside | 0.3-10 mcg/kg/min | none | Keep wrapped in opaque material- photosensitive; Cyanide may accumulate in renal/hepatic impairment |
| Norepinephrine Noradrenaline (“Levo”) | 2-25 mcg/min | none | Central line recommended |
| Octreotide | 50-100 mcg/hr | 50 mcg | May increase QTc |
| Phenylephrine (“Neo”) | 20-300 mcg/min | none | Reflex bradycardia; ok through PIV |
| Propofol | 5-200 mcg/kg/min | 1-2mg/kg | May accumulate over time |
| Vasopressin | 0.03- 0.04 Units/min | none |
Hyperglycemia Insulin Dosing
| Blood Glucose (mM) | Insulin Sensitive | Usual Insulin | Insulin Resistant |
|---|---|---|---|
| 7.7 – 10 | 0 | 2 | 3 |
| 10 – 12.2 | 2 | 3 | 4 |
| 12.2 – 14.4 | 3 | 4 | 5 |
| 14.4 – 16.6 | 4 | 6 | 8 |
| 16.6 – 19.4 | 5 | 8 | 10 |
| 19.4 – 22.2 | 6 | 10 | 12 |
| >22.2 | 8 | 12 | 14 |
- Insulin sensitive: Age >70, GFR below 24 ml/min, no history of DM
- Insulin resistant: BMI >35 kg/m2, home TDD insulin >80U, steroids >20mg prednisone
- Recommendation: If using IV then bolus and then set the drip at calculated amount.
- Always be careful when dosing insulin and remember to check and recheck the concentration!
- Always recheck your BG 30 – 60 min after dosing insulin.
- Avoid stacking insulin doses with SC regular insulin (happens with multiple doses within 60 minutes)
Antibiotics
| Antibiotic | Dose | Infusion Duration | Redosing interval |
|---|---|---|---|
| Ampicillin-sulbactam | 3g | 15-30 min | 2 h, redose 6 h |
| Azithromycin | 500 mg | 1 hr | |
| Cefazolin | 2g; 3g if >120 kg | 5 min | 4 h, redose 8h |
| Cefepime | 2g | 30 min | 4 h, redose 8 h |
| Cefoxitin | 1-2 g | 5 min | 2 h, redose 6 h |
| Cefuroxime | 1.5 g | 5 min | 3-4 h |
| Ciprofloxacin | 400 mg | 1 hr | 6 h |
| Clindamycin | 600-900 mg | 10-60 min | 6 h, redose 8h |
| Ertapenem | 1 g | 30 min | 24 h |
| Gentamicin | 1.5 mg/kg | 30-60 min | 24 h |
| Metronidazole | 0.5-1 g | 30-60 min | 8 h |
| Vancomycin | 10-15 mg/kg (max 2g) | 60 min/g | 24 h |
- Antibiotics should be given within 60 minutes prior to incision!
- Antibiotics also need to be redosed after every 1.5 L blood loss.
Other Medications
| Medication | Dose | Comment |
|---|---|---|
| Atropine | 0.5-1 mg bolus | For bradycardia, crosses BBB |
| Calcium Gluconate | 2-3 g | Give over 10 min |
| Dexamethasone | 4-8 mg IV bolus | PONV prevention; airway dose 10 mg |
| Glycopyrrolate | 0.2-0.4 mg bolus | For bradycardia; give with 1cc to 1cc ratio with neostigmine for reversal |
| Metoclopramide | 10 mg IV | Tx of gastroparesis, nausea |
| Naloxone | 0.04 mg q5 min | Dilute 1 cc Narcan in 9 cc saline |
| Neostigmine | 0.07 mg/kg | Max dose 5 mg. Give with glycopyrrolate |
| Potassium Chloride | 20 mEq infusion | Infuse at rate of < 20 mEq/hr; central line preferred but PIV ok at slow rate. |
| Protamine | variable | Give 0.5-1 cc test dose and monitor for hypotension. Dose is 10 mg protamine for every 1000 Units of heparin. |
| Vasopressin | Bolus 1-2 Units at a time | Take 1 cc of 20 Units/ml and dilute in 19 cc NS to make 1 unit/ml. Call attending before giving! |