The A to Z of MEDS
✓ | → ↓ ↑ ↔ ⇆ ← → ≥ ≤ ≠ ♀ ♂ µ « » ∆ °★ —βαμ
Atropin (0,5mg/ml) — anticholinergic drug / antimuscarinic (inhibits/reduces the parasymphatic nerve system i.e. parasympatholytic) — competitive antagonist of muscarinic acetylcholine receptor-types M1-M5. ∆ Effects: ↑HR, ↓Saliva production, also used to treat certain nerve agents and pesticide poisonings. ∆ Adverse: Dry mouth, Large pupils, Urinary retention, Constipation, Tachycardia. ∆ Contra: angle closure glaucoma, urinary retention. [FASS | WIKI]
∆ Dosage Brady: 0,5mg – 1mg / 1-2ml i.v.
Betapred (4mg/ml) — steorid drug, also called Betamethasone. ∆ Effects: Anti-inflammatory, decreases brain edema, alleviates PONV (Post Operative Nausea and Vomiting). ∆ Adverse: Increased risk of infections (suppresses the immune system), Muscle weakness, Psychosis, Long term: Adrenal insufficiency. Contra: No contraindications in life-threatening conditions. [FASS | WIKI]
∆ Dosage PONV: 4-8mg / 1-2 ml i.v.
Catapressan (150 µg/ml) — Klonidin — is an α2-adrenergic agonist used to treat high blood pressure and certain pain conditions. ∆ Effects: ↓BT ↓Pain ∆ Adverse: ↓HR ↑Vertigo/Nausea ↑Dry mouth ↑Constipation ∆ Contra: Severe bradycardia / Hypotension.
[FASS | WIKI]
∆ Dosage post-OP pain: 75-150 µg / 0,5-1 ml i.v.
Droperidol (2,5 mg/ml) — an antidopaminergic drug used as an antiemetic and as an antipsychotic. Droperidol and ondansetron are equally effective as antiemetics. ∆ Effects: ↓Nausea ∆ Adverse: ↓BT / ↑tiredness. ∆ Contra: Long QTc-Syndrome / hypokalemia / bradycardia / feokromocytom / coma / Parkinson’s / severe depression.
[FASS | WIKI]
∆ Dosage PONV: 1,25-2,5 mg / 0,5-1 ml i.v.
Efedrin (50mg/ml) — “Ephedrine” — CNS stimulant — stimulates adrenergic receptor system by ↑activity of nor-Epi at the postsynaptic αlpha- & βeta receptors, primary effect is achieved by releasing endogenous nor-Epi. Also bronkodilating — compared to Epi the bronkodilating effect of Efedrin are weaker but the duration longer. ∆ Effects: ↑BT & ↑HR. ∆ Adverse: Insomnia, Anxiety, Headaches, Hallucinations, Urinary retention. ∆ Contra: Patients with ischemic heart disease, arrhythmia’s, .
[FASS | WIKI]
∆ Dosage for hypotension: 5-10mg / 0,1-0,2 ml i.v.
Esmeron (10mg/ml) — Rokuronium — non-depolarizing NMB — A competitive antagonist for the nicotine acetyl-choline receptors at the NMJ, acts by dampening the receptor action causing muscle relaxation, effective within 60 seconds and lasts 45-60 minutes. ∆ Effects: ∆ Adverse: ↑HR / ↓BT ∆ Contra: No absolute contraindication ∆ Antidote: Bridion (Sugammadex) & Neostigmine (needs a TOF of at least 2).
[FASS | WIKI]
∆ Dosage: 0,6mg/ kg (usually 4-6 ml i.v.)
Fenylefrin (0,1mg/ml) — Phenylephrine — selective α-adrenergic receptor agonist → constriction of both arteries and veins. ∆ Effects: ↑BT, ↑SVR & ↓CO ↓HR (reflex-bradycardia). ∆ Adverse: agitation, headache, bradycardia, lung-edema, cardiac failure. ∆ Contra: peripheral vascular disease. [FASS | WIKI]
∆ Dosage for hypotension: 0,1-0,2 mg / 0,1-0,2 ml i.v. | Dosage infusion: 0,05-0,15 µg/kg/min = ca 3-20 ml/kg if 70 kg patient
Propofol 10mg/ml — potentiates GABAA receptor activity increasing inhibition. ∆ Effects: short acting medication that ↓consciousness within minutes and with minimal time in excitation phase (seconds). ∆ Adverse: Respiratory depression, ↓BT, vascular irritant although short effect (no harm if arterial or extra vascular injection). ∆ Contra: None. [FASS | WIKI]
∆ Dosage induction: 2mg/kg (Children: 2,5-3,5 mg/kg) | Dosage maintain: 4-10 mg/kg/h
Dosage sedation: 0,5-4mg/kg/h
Remifentanil (50µg/ml | 2mg Remifentanil + 40 mg NaCl 9mg/ml) — ULTIVA — potent, short-acting, synthetic opiod analgesic drug, specific μ-receptor agonist. ∆ Effects: rapid onset and rapid recovery time when sedating during surgery. ∆ Adverse: respiratory depression, ↓HR, ↓Arterial pressure, ↓RR, ↓TV, and common adverse effect in conscious/recovering patients: dizziness. ∆ Contra: contains glycin and therefor non-usable in epidural/intrathecal analgesia. Can NOT be used as only anesthetic during induced unconsciousness (Needs to be combined either with inhalation gases or i.v. Propofol). [FASS | WIKI]
∆ Dosage induction: bolus 1µg then 0,5-1µg starting dose | Dosage maintaining: 0,02-0,5 µg/kg/min (in combination with e.g. Propofol at appropriate doses)
Robinul (0,2mg/ml) — Glykopyrronium — muscarinic anticholinergic and thus inhibits the effect of acetylcholine on structures such as smooth muscles, cardiac muscles, SA & AV node, exocrine glands and to a certain degree autonomic ganglia = inhibits muscarinic symptoms. Does not cross BBB = few to no central effects. ∆ Effects: ↓bronco-spasms, ↓bradycardia, ↓hypermotility in the GI-tract, ↓salivary secretion ∆ Adverse: Related to its effects (dry mouth, takycardia, arrythmia etc..). ∆ Contra: angle closure glaucoma, myasthenia gravis, paralytic ileus, pyloric stenosis.
[FASS | WIKI]
∆ Dosage pre-induction: 0,2mg – 0,4mg / 1-2ml
Sevoflurane — sweet-smelling, nonflammable, highly flourinated methyl isopropyl ether used as an inhalational anesthetic for induction and maintenance of general anesthesia. After desflurane, it is the volatile anesthetic with the fastest onset. Sevoflurane is less lung-irritating than desflurane. Acts as a positive allosteric modulator of the GABAA receptor, and also as an NMDA receptor antagonist. ∆ Effects: Less soluble than iso/halothane and therefore easier to regulate, provides fast onset and offset of unconsciousness. ∆ Adverse: Less than <5% is metabolised in the liver to HFIP. Can cause malignant hyperthermia in predisposed patient (hexaflourisopropanol). ∆ Contra: Patients with liver disease, ↓kidney function, and ↑ICP (all of them relative contraindications).
[FASS | WIKI | Narkosguiden]
∆ Dosage induction: 0,5-1,0 % / Maintain: 0,5-3% (Usually MAC 1,2 – 1,4 during surgical intervention)
— usually less in older patients and less when combined with N2O (MAC-value decreases with 25-50% in adults and 25% in children when 60-65% N2O is administered simultaneously)
Suxametason (50 mg/ml) — Celokurin / Succinylcholine / Sux — depolarizing NMB — depolarizing paralytic, nicotine receptor agonist causing persistent depolarization, effective within 30-60 seconds (look for fasciculations and wait for them to stop) and lasts 2-6 minutes, used for RSI, can result in hyperkalemia and (rare) malignant hyperthermia. A hygroscopic compound that consists of two acetylcholine molecules linked by their acetyl groups, that bind to nicotine acetylcholine receptors, resulting in opening the monovalent cation channel; a disorganized depolarization of the motor end-plate occurs and calcium is released from the sarcoplastic reticulum → maintaining membrane potential above threshold → does not allow muscle cell to repolarize → as the calcium is taken up by the sarcoplasmic reticulum the muscle relaxes → therefore muscle flaccidity rather than tetany following fasciculations: the result is depolarization and transient fasciculations, followed by paralysis = phase 1 = no phase one antidote. ∆ Effects: transient fasciulations & paralyis ∆ Adverse: ↑hypercalcemia /↑hyperkalemia /↑ Nausea & Vomiting / ↑Muscle Soreness /↑Rhabdomyolysis /↑Apnea /↑Cardiac arrhytmias /↓HR / & (rare) Malignant Hyperthermia (treated with Dantrolene). ∆ Contra: Muscle disease / Severe kidney failure / crush patients / spinal cord injury / large burns / Lambert-Eaton Syndrom / Botulism / Myasthenia Gravis.
[FASS | WIKI | VIDEO i | Video ii | Video iii]
∆ Dosage: 1mg/kg (ca 50mg – 100 mg / 1-2 ml i.v.)