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Anesthetics /Sedatives

dexmedetomidine (Precedex ®) etomidate (Amidate ®)
fospropofol disodium -LUSEDRA™ ketamine (Ketalar ®)
methohexital (Brevital ®) pentobarbital (Nembutal ®)
propofol (Diprivan ®) thiopental (Pentothal ®)
   

dexmedetomidine  (Precedex ®)  top of page

Alpha2-adrenergic agonist sedative.
Dosing (adults):
 ICU sedation: Initial: Loading infusion of 1 mcg/kg IV over 10 minutes, followed by a maintenance infusion of 0.2-0.7 mcg/kg/hour (individualized and titrated to desired clinical effect); not indicated for infusions lasting >24 hours (Solution must be diluted prior to administration.)

Supplied: 100 mcg/ml - 2 ml Injection

etomidate  (Amidate ®)  top of page

Ultrashort-acting nonbarbiturate hypnotic.
Dosing (adults):
Anesthesia: Initial: 0.2 to 0.6 mg/kg IV over 30-60 seconds for induction of anesthesia; maintenance: 5-20 mcg/kg/minute. Produces rapid induction of anesthesia with minimal cardiovascular effects.

Onset of action: 30-60 seconds.
Peak effect: 1 minute.
Duration: 3-5 minutes ( terminated by redistribution).
Supplied: 2 mg/ml (10 ml, 20 ml) injection.

fospropofol disodium -LUSEDRA™: top of page

fospropofol disodium -LUSEDRA™ Injection CIV

Mechanism of Action
:
Fospropofol disodium is a prodrug of propofol. Following intravenous injection, fospropofol is metabolized by alkaline phosphatases. For every millimole of fospropofol disodium administered, one millimole of propofol is produced (1.86 mg of fospropofol disodium is the molar equivalent of 1 mg propofol).

INDICATIONS AND USAGE:
LUSEDRA is a sedative-hypnotic agent indicated for monitored anesthesia care (MAC) sedation in adult patients undergoing diagnostic or therapeutic procedures.

USE IN SPECIFIC POPULATIONS
Patients geq65 years of age should receive the modified dosing regimen.
Patients with severe systemic disease (ASA P3 or P4) should receive the modified dosing regimen.

DOSAGE AND ADMINISTRATION:
Use supplemental oxygen in all patients undergoing sedation with LUSEDRA.  Continuously monitor with pulse oximetry, electrocardiogram, and frequent blood pressure measurements.

Standard dosing regimen: initial intravenous bolus dose of 6.5 mg/kg followed by supplemental doses of 1.6 mg/kg as needed. No initial dose should exceed 16.5 mL; no supplemental dose should exceed 4 mL.

Modified dosing regimen [for patients who are geq65 years of age or who have severe systemic disease (ASA P3 or P4)]: 75% of the standard dosing regimen.

AAdminister supplemental doses only when patients can demonstrate purposeful movement in response to verbal or light tactile stimulation and no more frequently than every 4 minutes.

Adults who weigh >90 kg should be dosed as if they are 90 kg; adults who weigh <60 kg should be dosed as if they are 60 kg.

Intended for single-use administration only.

DOSAGE FORMS AND STRENGTHS::
Injection, solution containing 1,050 mg fospropofol disodium per 30 mL.

CONTRAINDICATIONS::
None

WARNINGS AND PRECAUTIONS
-A person trained in the administration of general anesthesia and not involved in the conduct of the diagnostic/therapeutic procedure should manage treatment of patients with LUSEDRA.
-Respiratory depression
-Hypoxemia
--Hypotension

ADVERSE REACTIONS
Most common adverse reactions (> 20%) are paresthesia and pruritus. (6)

TTo report SUSPECTED ADVERSE REACTIONS, contact Eisai Inc. at 1-888-422-4743 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

DRUG INTERACTIONS
As with other sedative-hypnotic agents, LUSEDRA may produce additive cardiorespiratory effects when administered with other cardiorespiratory depressants such as benzodiazepines and narcotic analgesics.

ketamine  (Ketalar ®)  top of page

Ketalar is a rapid-acting general anesthetic producing an anesthetic state characterized by profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression.

Dosing
(adults): Anesthesia (sedation, analgesia): IM: 3-8 mg/kg. IV: Range: 1-4.5 mg/kg; usual induction dosage: 1-2 mg/kg.
Maintenance
: Supplemental doses of 1/3 to 1/2 of initial dose.
Onset of action: (IV): General anesthesia: 1-2 minutes; Sedation: 1-2 minutes. (IM): General anesthesia: 3-8 minutes.
Duration: 5-15 minutes IV; 12-25 minutes IM.
Supplied: Injection, solution: 50 mg/ml (10 ml); 100 mg/ml (5 ml). Ketalar®: 10 mg/ml (20 ml); 50 mg/ml (10 ml); 100 mg/ml (5 ml).

methohexital  (Brevital ®)  top of page

Ultra short-acting IV barbiturate anesthetic.

Dosing (adults): Anesthesia: IV: Induction: 50-120 mg to start; 20-40 mg every 4-7 minutes. (doses must be titrated to effect).
Onset: IV: Immediately
Duration: Single dose: 10-20 minutes
Supplied: 500 mg, 2.5 g, 5 gram (powder for reconstitution)

pentobarbital (Nembutal ®)   top of page

Short-acting barbiturate with sedative, hypnotic, and anticonvulsant properties.

Dosing (adults): Hypnotic: IM: 150-200 mg. IV: Initial: 100 mg, may repeat every 1-3 minutes up to 200-500 mg total dose. Preoperative sedation: IM: 150-200 mg.

Barbiturate coma in head injury patients or status epilepticus: IV: Loading dose: 5-10 mg/kg given slowly over 1-2 hours; monitor blood pressure and respiratory rate; maintenance infusion: initial: 1 mg/kg/hour; may increase to 2-3 mg/kg/hour; maintain burst suppression on EEG. Status epilepticus: IV: Loading dose: 2-15 mg/kg given slowly over 1-2 hours; maintenance infusion: 0.5-3 mg/kg/hour.
Onset: IM: 10-15 minutes. IV: ~ 1 minute.
Duration: IV: 15 minutes

Supplied
: Injection: 50 mg/ml (20 ml, 50 ml).

propofol (Diprivan ®)  top of page

Dosing (adults):
Induction: General anesthesia: ASA I or II, <55 years: 2-2.5 mg/kg IV (~40 mg every 10 seconds until onset of induction). Cardiac anesthesia: 0.5-1.5 mg/kg IV (~20 mg every 10 seconds until onset of induction). Neurosurgical patients: 1-2 mg/kg IV (~20 mg every 10 seconds until onset of induction).

Maintenance
: ASA I or II, <55 years: IV infusion: Initial: 150-200 mcg/kg/minute for 10-15 minutes; decrease by 30% to 50% during first 30 minutes of maintenance; usual infusion rate: 100-200 mcg/kg/minute (6-12 mg/kg/hour). IV intermittent bolus: 20-50 mg increments as needed.

 ICU sedation in intubated mechanically-ventilated patients: Avoid rapid bolus injection; individualize dose and titrate to response. Continuous infusion: Initial: 0.3 mg/kg/hour (5 mcg/kg/min); increase by 0.3-0.6 mg/kg/hour (5-10 mcg/kg/min) every 5-10 minutes until desired sedation level is achieved; usual maintenance: 0.3-4.8 mg/kg/hour (5-80 mcg/kg/min) or higher.

Onset: Anesthetic: Bolus infusion (dose dependent): 9-51 seconds (average 30 seconds).
Duration
(dose and rate dependent): 3-10 minutes.
Supplied: Injection: 10 mg/ml (20 ml, 50 ml, 100 ml).

thiopental (Pentothal ®)   top of page

Dosing (adults):
Anesthesia: IV: Induction: 3-5 mg/kg.
Maintenance: 25-100 mg as needed. Increased intracranial pressure: IV: Children and Adults: 1.5-5 mg/kg/dose; repeat as needed to control intracranial pressure.

Seizures: I.V.: 75 to 250 mg/dose, repeat as needed.

Renal dosing: crcl <10 ml/minute: Administer 75% of normal dose.
Onset: Anesthetic: IV: 30-60 seconds.
Duration: 5-30 minutes.

Supplied: Powder for reconstitution: 250 mg, 400 mg, 500 mg, 1 g.

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.
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