Intravenous Anesthetics

Induction

Single Agent1
(g/kg/min)

Balanced Anesthesia1
Maintenance3
(g/kg/min)
5

Conscious Sedation or Analgesia1

Loading Dose
(g/kg)

Maintenance (Sole Anesthetic)2,3 Loading Dose

(g/kg)

Maintenance3
(g/kg/min)

etomidate (Amidate ) 0.2 - 0.6 mg/kg (for age >10) N/R 100/min for 10 min, then 10 15 - 20/min for 10 min then 2.5 - 7.55 ketamine (Ketalar) 1 - 2 mg/kg (5-10 IM/PR) 30 - 100 1000 - 2000 10 - 50 200 - 1000 5 - 20 methohexital (Brevital1%) 1.0 - 2.0 (20-30 PR 10%) mg/kg N/R 1000 - 2000 50 - 150 500 - 1000 10 - 50 2.0 - 2.5 (2.5-3.5 child) mg/kg 100 - 200 1000 - 2000 100 - 200 100 - 150/min until sedation then 25 - 75 propofol (Diprivan) midazolam (Versed) 0.15 - 0.35 mg/kg 0.25 - 1.5 50 - 150 0.25 - 1.0 20 - 100 (10 g/kg increments) 0.25 - 1.0 thiopental (Pentothal2.5%) 3 - 6 (30-40 PR 10%) mg/kg N/R 2000 - 4000 200-300 1st 20 min, 30-70 thereafter 500 - 2000 30 - 80 alfentanil (Alfenta) 130 - 245 g/kg (500-2000 g/kg total) 1.0 - 8.0 50 - 150 0.5 - 3.0 10 - 25 0.25 - 1.0 fentanyl (Sublimaze ) 5 - 40 g/kg (50-150 g/kg total) 0.1 - 1.0 5 - 15 0.03 - 0.1 1-6 0.01 - 0.04 morphine (Duramorph) 1 - 3 mg/kg (over 10-15 min) N/R 50 - 200 1 - 3 g/kg/min ( muscle rigidity) N/R 0.5 - 2.0 0.05 - 2.0 0.5 - 1.0 (infused over 30-60 sec) 0.025 - 0.2 remifentanil (Ultiva ) sufentanil (Sufenta) 2 - 10 g/kg (15-30 g/kg total) 0.05 - 0.1 0.25 - 2.0 0.01 - 0.04 0.1 - 0.5 0.005 - 0.01 1. Dosage may be lower if used in combination with other agents or physiologic changes such as extremes of age, pregnancy or shock. 2. Infusion doses when drug is used as the single agent after induction dose (usually for cardiac surgery). 3. After loading dose a higher infusion rate should be used initially to compensate for distribution into peripheral tissues. 4. Agents used as adjuvants to anesthesia with a low dose inhalational agent and/or narcotic, muscle relaxant, amnestic, anoxiolytic, analgesic as needed. Loading dose given after induction with another agent. 5. Approved for only short procedures owing to inhibition of corticosteroid synthesis.
opioids non-opioid anesthetics

Malignant Hyperthermia Protocol (Acute Phase Treatment)

Neuromuscular Blockers (doses in mg/kg)

IV Intubating Child Intubating RSI ED95 Maintenance2 succinylcholine (Anectine) 0.6 (0.3 - 1.1) 1 - 2 IV (3-4 IM) 1.0-1.5 0.3-0.5 30 - 150 g/kg/min laryngospasm 20 mg IV bolus 0.1 - 0.2 IV atracurium1 (Tracrium) 0.5 (0.3 - 0.6) 0.3 - 0.4 (age < 2) 0.23 3 - 15 g/kg/min cisatracurium1 (Nimbex) 0.15 (0.15 - 0.2) 0.1 (age 2-12) 0.4 0.05 1 - 2 g/kg/min doxacurium (Nuromax) 0.05 (0.05 - 0.08) 0.03 - 0.05 0.025 d-tubocurarine1 (curare) 0.5 - 0.6 0.6 (0.3 Neonate) 0.51 1 - 6 g/kg/min metocurine (Metubine ) 0.3 - 0.4 0.2 - 0.3 0.28 1 0.2 - 0.25 (age 2-12) 0.08 5 - 15 g/kg/min mivacurium (Mivacron ) 0.2 (0.15 - 0.25) pancuronium (Pavulon) 0.08 - 0.12 0.06 - 0.1 0.07 1 - 15 g/kg/min pipecuronium (Arduan) 0.07 - 0.1 0.04 - 0.06 (age 1-14) 0.05 rocuronium1 (Zemuron) 0.6 (0.45 - 1.0) 0.6 - 0.8 (1.8 IM) 0.6-1.2 0.3 6 - 16 g/kg/min vecuronium1 (Norcuron) 0.1 (0.08 - 0.2) 0.1 (age 1-10) 0.3-0.4 0.057 0.8 - 1.2 g/kg/min 1. For priming or defasiculating doses, use 15% of ED95 3-5 min prior to induction. 2. Infusion doses. For maintenance bolus dosing use 20-40% of ED95.
aminosteriods benzylisoquinolines

Reversal of Neuromuscular Blockade

atropine 0.015-0.03 mg/kg and////////////////////////////////////// 0.5-1.0 mg/kg IV edrophonium (Tensilon) glycopyrrolate (Robinul) 0.01-0.02 mg/kg and ////////////////////////////////////// 0.04-0.08 mg/kg IV neostigmine (Prostigmin)

Postoperative Medications (Analgesics, Antiemetics, Reversal)

acetaminophen (Tylenol) butorphanol (Stadol) ketorolac (Toradol) nalbuphine (Nubain) droperidol (Inapsine) dolasetron (Anzemet) metoclopramide (Reglan) ondansetron (Zofran) umazenil (Romazicon) //////////////////////////////////// nalmefene (Revex) ///////////////////////////// naloxone (Narcan) ///////////////////////////// 20-40 mg/kg PR, 5-15 mg/kg PO 0.5-2.0 mg (0.01-0.04 mg/kg) IV; 1-4 mg IM 30 mg (0.5 mg/kg) IV; 60 mg (1.0 mg/kg) IM 5-10 mg (0.1-0.3 mg/kg) IV/IM/SC 0.625-2.5 mg (10-20 g/kg ) IM/IV 12.5 mg IV (0.35 mg/kg child age 2-16 yrs. to max 12.5 mg) 5-20 mg (0.1 mg/kg) PO/IM/IV (IV given over 1-2 min) 4 mg undiluted IV/IM over > 30 sec. (0.1 mg/kg child 40 kg) 0.2 mg IV q min (up to 1 mg max/5min, 3 mg max/1hr) 0.1-0.25 g/kg IV q 2-5 min to max of 1 g/kg 0.1-0.4 mg IM/IV/SQ q3min (1-10 g/kg child) Mixture/Concentration
Multiplier2
Analgesics

1. Get Help. Get Dantrolene. Stop succinylcholine and all inhalational anesthetics. Hyperventilate with 100% O2 at max ows (>10 L/min). 2. Dantrolene (Dantrium) 2.5 mg/kg bolus rapidly. Titrate for control of MH Sxs. Max dose = 10 mg/kg but sometimes more is needed. Each vial contains dantrolene 20 mg with mannitol 3 gm and must be mixed with 60 ml sterile water. 3. Treat acidosis with NaHCO3 guided by ABGs, otherwise use1-2 mEq/kg. 4. Start cooling techniques: Give cold NS IV (15 ml/kg q15min 3). Lavage stomach, bladder, rectum and wound with cold NS. Surface cooling with ice and hypothermia blanket. Monitor for overtreatment. 5. Dysrhythmias usually respond to Rx of acidosis and hyperkalemia. If not, administer standard antiarrhythmic with exception of Ca2+ channel blockers (may cause hyperkalemia and CV collapse). 6. Determine and monitor end-tidal CO2, arterial, central or venous BG, K+/lytes, urine output, PT/PTT and Ca2+ for baseline. Repeat prn. 7. For hyperkalemia: hyperventilate, NaHCO3, Insulin 10U in 50 cc D50 and titrate to serum K+. If needed add 2-5 mg/kg of CaCl2. 8. Ensure urine output of > 2 ml/kg/hr with IV uids and/or mannitol (0.25 g/kg) or furosemide (1 mg/kg). Consider CVP or PA. 9. Sudden cardiac arrest in children after succinylcholine should be treated as acute hyperkalemia first. Give CaCl2 with above Rx (#7). Presume subclinical muscular dystrophy and consult neurologist. MH Emergency HOTLINE: (800) 644-9737; MHAUS MH Info-by Fax: (800) 440-9990 MAC (vol %)1 Vapor Pres. Partition Cfcients
mm Hg Blood:Gas Brain:Blood >60 yr Adult Child Infant Neonate

Inhalational Anesthetics

Autonomic / Cardiovascular Drugs

Dosages
IV Push or IV infusion Dilution Final Loading Dose (g/kg/min) (in 250 ml) Conc.
Adrenergic Agonists (listed from alpha to beta)

0.15-0.75 20 mg 80 g/ml 0.05-0.50 8 mg 32 g/ml 0.5-7.0 100 mg 400 g/ml 0.01-0.03 4 mg 16 g/ml > 0.03-0.15 1 mg 4 g/ml + 0.15-0.50 ephedrine 5-10 mg N/R dopamine N/R renal dose 0.5-3.0 200 mg 800 g/ml .375=5 dose 3.0-10 400 mg 1.6 mg/ml .1875=5 1 + 10-20 800 mg 3.2 mg/ml .09375=5 dobutamine N/R 2.0-30 250 mg 1 mg/ml 0.3=5 isoproterenol 20-60 g 0.01-0.5 2 mg 8 g/ml .1875=.025 inamrinone 0.75 mg/kg 5.0-20 100 mg 400 g/ml 0.75=5 milrinone 50 g/kg slowly 0.375-0.75 50 mg 200 g/ml 0.15=0.5 hydralazine ////////////////////// 2.5-5 mg q15min: max 20-40 mg (or 0.2-0.5 mg/kg) nitroglycerine 0.1-7.0 50 mg 200 g/ml 0.3=1.0 /////////////////////// 25-50 g nitroprusside 50 mg 200 g/ml 0.3=1.0 ////////////////////// 0.5-1.0 g/kg 0.1-10 trimethaphan 7-85 250 mg 1 mg/ml 0.3=5 /////////////////////// 1.0-20 mg diltiazem 0.25 / 0.35 mg/kg 1.0-3.0 100 mg 400 g/ml 0.15=1.0 nicardipine 0.5-2.0 mg 1.0-4.0 25 mg 100 g/ml 0.6=1.0 nifedipine 10-20 g/kg 1.0-3.0 50 mg 200 g/ml 0.3=1.0 verapamil 75-150 g/kg 1.0-5.0 50 mg 200 g/ml 0.3=1.0 esmolol 0.25-1.0 mg/kg 50-300 2.5 g 10 mg/ml 0.3=50 labetalol 0.1-0.25 mg/kg 2.0 -8.0 g/min metoprolol 2-15 mg propranolol 0.5-1.0 mg, then 1-5 mg amiodarone 150 mg 1st 10 min, 360 mg next 6 hours, 540 mg remaining 18 hours bretylium 5 then 10 mg/kg 15-30 500 mg 2 mg/ml 0.6=20 lidocaine 1-3 mg/kg 20-60 1g 4 mg/ml 0.3=20 procainamide 500 mg over 30 min15-60 1 g in D5W 4 mg/ml 0.3=20

phenylephrine 50-200 g norepinephrine N/R metaraminol 0.5 mg epinephrine 2-10 g dose

Wt.=Rate .075=0.1 .1875=0.1 0.75=5 .1125=.03 .45=.03

desurane (Suprane) 5.2 7.3-6.0 8.1 10.0 9.2 664 0.42 1.29 enurane (Ethrane) 1.4 1.7 175 1.91 1.4 halothane (Fluothane ) 0.6 0.77 0.95 1.2 0.87 241 2.3 2.9 isourane (Forane ) 1.05 1.15 1.6 1.87 1.60 238 1.4 2.6 nitrous oxide 104 39,000 0.47 1.1 160 0.60 1.7 sevourane (Ultane) 1.7-1.4 2.6-2.1 2.5 3.0 3.3 1. For no movement to noxious stimuli in 95% pts. use 1.25-1.3 MAC. For blocking adrenergic response (MAC-BAR) use 1.5 MAC. For eye opening on command (MAC-awake) use 0.5 MAC. Clinical Adrenergic Receptor Activity Hemodynamic Effects1 Duration Direct Indirect Alpha Alpha Alpha Beta Beta CO Inotrop HR MAP VR SVR PVR RBF (IV) 1 art 1 ven 2 1 2 preload afterload < 5 min ++++ ++++ +++++ +,0 0 0 0, 0, reex 0, 2-10 min ++++ +++ +++ +++++ ++++ 0 ,0, reex 30 min + +++ ++ ++ + +++ 0 0, reex 5-10 min ++++ + + + ++++ ++++ 0,
++++ +++ +++ ++ ++++ ++++ ++++ +++++ +++++ +++ ++++ ++++ 3-10 min ++ +++ ++ +++ ? +++ ++ < 10 min ++++ 0 ++++ Dopaminergic receptor stimulation +++ + + ++++ ? +++ +++++ +++ + +++++ ++++ ? +++++ +++ < 10 min ++++ 0+ ? 0 ++++ ++ 1-5 min ++++ 0 0 0 +++++ +++++ 0.5-2 hr 0 0 0 0 0 0 0.5-2 hr 0 0 0 0 0 0 2-4 hr 0 arteriolar dilation 0 0 3-5 min 0 + mostly venous dilation 1-2 min 0 dilates veins & arterioles (cyanide toxicity) 5-10 min 0 dilates veins & arterioles (nicotinic ganglion blocker) 1-3 hr 0 0 0 0 0 0 0 10-15 min 0 0 0 0 0 0 0 4-12 hr 0 + 0 0 0 0 0 4-6 hr 0 0 0 0 0 0 0 10 min 0 0 0 0 0 0 2-4 hr 0 0 + 5-8 hr 0 0 0 0 0 1-6 hr 0 0 0 0 0 Antidysrhythmic Class III; K+ channel blockade (delays phase 3 repolarization) 6-24 hr + Class III; delays phase 3 repolarization 15-30 min Antidysrhythmic Class Ib; Na+ blockade ( depolarization) 2-4 hr Antidysrhythmic Class Ia; prolongs repolarization and depolarization ,0 ,0, ,0, ,0 0, 0 ,0 0 0 0 reex reex reex 0 ,0 0 reex ,0 0, 0 0 0, 0, reex reex reex 0, ,,0 , 0, 0, 0 0, 0 0 0 reex 0, 0, 0 0, 0 , then 0 0 0 0, 0, 0, ,0, 0, 0, ,0, ,0 ,0 ,0, 0, 0,

Reversal

Antiemetics

,0

PDE

Ca Channel Blocker

Vasodilators

0, 0 0,

Beta Blockers

1. If more than one effect on hemodynamics, effects listed rst are seen early or with lower dosages. CO=Cardiac Output; Inotrop=contractility; HR=Heart Rate; MAP=Mean Arterial Pressure; VR=Venous Return (preload, filling pres.); SVR=Systemic Vascular Resistance (afterload); PVR=Pulmonary Vascular Resistance; RBF=Renal Bloodow. 2. Multiplier (1st #) x pts wt. in Kg. gives cc/hr to set pump for infusion rate of (2nd #) in g/kg/min at conc. of drug on that line (Example: nitroglycerine 50 mg/250 ml = 200 g/ml. For 50 Kg pt, 50 x 0.3 = 15 cc/hr which = 1.0 g/kg/min). LEGEND: Opioids /////Opioid Antagonists Non-Opioid Anesthetics Vasopressors /////Vasodilators Local Anesthetics Benzodiazepines Muscle Relaxants /////Anticholinesterases ACh Antagonists Tranquilizers

Antiarrythmics

Further dosing Indications 6 then 12/12 mg IV push 1st drug for PSVT. Does not convert atrial fib/flutter or VT 300 mg IV initial for Cardiac Arrest. Max cumulative dose 2.2 g IV/24h. then 150 mg q3-5 min 1-15 mg/min IV for stable wide complex tachycardia. to 0.04 mg/kg max dose. For asystole/PEA/bradycardia. atropine 1.0 mg IV q 3-5 CaCl2 2-4 mg/kg q10 min prn for cardiac arrest with K+, Ca, or Ca chan block OD. epinephrine diltiazem 0.25 mg/kg over 2 min after 15 min, 0.35 mg/kg; infuse at 5-15 mg/hr, titrate to HR. glucose for VF/pulseless VT, asystole, and PEA. epinephrine 1.0 mg q3-5 min lidocaine isoproterenol 2-10 g/min Not indicated for cardiac arrest. Titrate to adequate HR. magnesium lidocaine 1.0-1.5 mg/kg initial 0.5-0.75 mg/kg after 5-10 min; for persistant VF/VT NaHCO3 30-50 g/kg/min infusion Max total dose 3.0 mg/kg. Volume magnesium 1-2 g in 100 ml D5W infuse at 0.5-1 g/hr (for torsades, Mg, refractory VF). NaHCO3 1 mEq/kg initial ABG; 0.3 wt (kg) base decit; do not mix with then 0.5 mEq/kg q10 min catecholamines or calcium salts, helpful with K+. NPO Orders procainamide 20 mg/min IV infusion maximum 17 mg/kg, 100 mg IVP q5m if refractory VF/VT 06 months: formula1 up to 4h; clear liquids2 up to 2h; NPO 2 hrs. 40 U IV/IO/ET 1 Alternative pressor to epinephrine in Cardiac Arrest. 636 months: formula1 or food1 up to 6 hrs, clear liquids2 to 3 hrs; NPO 3 hrs. vasopressin 1 3 > 36 months: food up to 8 hrs, clear liquids up to 3 hrs; NPO 3 hrs . NAVEL (Naloxone, Atropine, Vasopressin/Valium, Epinephrine, Lidocaine) may be given via ETT in 10cc NS, usually in 2-3 IV dose. Medications: Should be taken with 30 ml of water up to 1 hr before surgery. Pediatric Preoperative/Sedative Medications (age > 6 mo.) 1. Includes milk or milk products. 2. Includes breast milk. 3. Ingestion of 150 ml of water 3 hours before diazepam (Valium) 0.3-0.4 mg/kg PO/PR/IM (90-120 min pre-op) operation reduces residual gastric volume compared to a prolonged fast (except the obstetric and trauma patient). midazolam (Versed) 0.5-1.0 mg/kg PO; 0.2 -0.3 IN; 0.1-0.2 IM; 0.1 IV; 1.0 PR Fentanyl Oralet 5-15 g/kg OT (5 g/kg adults) (20-40 min pre-op) Fluid Management st nd morphine 0.1-0.2 mg/kg IM (45-60 min pre-op) Maintenance: 4 ml/kg/hr -1 10kg, 2 ml/kg/hr -2 10kg, 1 ml/kg/hr - remainder. sufentanil (Sufenta ) 1.5-3.0 g/kg intranasal (IN) (For Pts > 20 kg body weight, take Wt in kg + 40 = maintenance in ml/hr) 65-100 mg/kg PO/PR chloral hydrate (Notec ) Decit: Maintenance uids per hour hrs NPO without hydration. clonidine (Catapress) 2.5 g/kg PR/IV ; 4 g/kg PO (105-120 min pre-op) Replace 1/2 of decit in 1st hr, 1/4 in 2nd and 1/4 in 3rd hr. 3-5 mg/kg IM; 6 PO; 8-10 PR; 0.25-0.75 IV; 3 IN Blood Loss: Replace with LR: 3 to 1; blood, colloid, or Hespan (Max 20 ml/kg/day): 1 to 1 ketamine (Ketalar) methohexital (Brevital) 25-30 mg/kg PR (2-10%sln), 6-10 IM (5% sln) Third-Space or Insensible Losses: pentobarbital (Nembutal) 2.0-4.0 mg/kg PO/PR/IM (or secobarbital Seconal) 2h pre-op Intraabdominal, Hip:12-15 ml/kg/hr 1st hr, 6-10 ml/kg/hr thereafter thiopental (Pentothal) 20-30 mg/kg PR (2.5-10% sln); 1.0-2.0 mg/kg IV Extremities, Intrathoracic: (Noncardiac), 6-10 ml/kg/hr Ped IM Cocktail: midazolam 15 g/kg , ketamine 3-3.5 mg/kg, glycopyrrolate 10 g/kg for drying TURP: 3-6 ml/kg/hr *watch for sudden expansion from irrigant Ped PO Cocktail: midazolam 0.4-0.5 mg/kg, ketamine 4-5 mg/kg, glycopyrrolate 20 g/kg for drying Trauma: Mild - 4 ml/kg/hr, Mod. - 6 ml/kg/hr, Severe - 8 ml/kg/hr Urine Output: Adjust uids to maintain at 0.5-1.0 ml/kg/hr; 2.0 infant Local Anesthetics Relative pKa Onset Duration (hrs) Toxic Doses3 (mg/kg) Endotracheal Tubes/Airway Management Potency Spinal Epidural Infiltrate Not exceed Plain With Epi Age Size (mm ID) Blade Dist@Lip LMA; Inflate 2-chloroprocaine (Nesacaine) 1 9.1 rapid 0.5-1.01 1-1.52 1000 mg 11 14 Premature (1-2.5 kg) *2.5-3.0 0 Mil 8-10 N/A cocaine 2 rapid N/R 0.5-2.0 200 mg 1.5-3 N/R Term-6 mo.(2.5-4 kg) *3.0 1 Mil 10-11 #1; 2-4 cc 1 8.9 rapid 0.5-1.51 0.5-1.52 0.5-1.01 800 mg 8 14 procaine (Novocain) tetracaine (Pontocaine) 6-12 mo. (5-7 kg) *3.5/3.0 1 Mil 11 #1; 2-4 cc 8 8.6 slow 1.0-(4-6)1 3-52 6.01 100 mg 1-1.5 2.5 2 12-20 mo. (7-10 kg) *4.0/3.5 1.5 Mil 12 #2; 10 cc bupivacaine (Marcaine ) 8 8.1 mod 1.5-2.5 3-4 4.0-12 200 mg 2 2-3 2 years (12 kg) *4.5/3.5 1.5 Mil 13 #2; 10 cc etidocaine (Duranest) 6 7.7 rapid N/R 2.5-3.52 3.0-12 400 mg 6 8 lidocaine (Xylocaine) 4 years (14 kg) *5.0/4.0 2 Mil 14 #2; 10 cc 2 7.9 rapid 1.0-1.5 2-32 1.0-3.01 500 mg 4.5 7 6 years (18 kg) *5.5/4.5 2 Mil/Mac 15-16 #2; 10 cc mepivacaine (Carbocaine) 2 7.6 mod N/R 2-3.52 2.0-3.0 500 mg 4 7 8 years (24 kg) *6.0/5.0 2 Mil/Mac 16-17 #2.5; 14 cc prilocaine (Citonest) 2 8.0 rapid 1-32 1.5-3.01 600 mg 6 9 ropivacaine (Naropin) 10 years (30 kg) 6.5 2-3 Mil/Mac 17-18 #2.5; 14 cc 8 8.1 mod 1.5-2.5 3-42 9-11 2.5 2-3 12 years (>30 kg) 7.0 3 Mil/Mac 18-20 #3; 20 cc N/R = not recommended. 1. Duration prolonged with epinephrine (200-300 g intrathecal). 2. With epinephrine 1:200,000. Adult Normal (50-70 kg)7.0-8.0 3 Mil/Mac 20-22 #4; 30 cc 3. Toxicity is dependent upon site of injection: IV > intercostal > caudal > epidural > brachial plexus > subcutaneous > topical Adult Large (70-100 kg) 8.0-9.0 3-4 Mil/Mac 22-24 #5; 40 cc Hemodynamic Formulas Pregnancy 6.5-7.0 3-4 Mac 20-22 N/R Variable Equation Normal Values Adult Nasal Intub. 6.5-7.5 3-4 Mil/Mac add 2-3 N/A Cardiac index (CI) CO/BSA 2.8-4.2 lmin-1m-2 ETT Size (mm) = (age 4) + 4 or [height (cm) 20] *uncuffed Stroke volume (SV) CO/HR 1000 60-90 mlbeat-1 Distance at lip (cm) = 3 Size (mm), Nasal = 4 Size Stroke index (SI) SV/BSA 40-60 mlbeat-1m-2 Mean arterial pressure (MAP) Diastolic pres. + 1/3 Pulse pres. 80-120 mm Hg Estimating Blood Loss Systemic vascular resistance (SVR) [(MAP - CVP) CO] 80 900-1400 dynes-cm-sec-5 Suction Losses: Blood in suction canister minus irrigation. [(MAP - CVP) CI] 80 1900-2400 dynes-cm-sec-5 Sponge Losses, Blood Soaked: Raytec = 15 ml; Lap = 80 ml Systemic vascular resistance index (SVRI) Pulmonary vascular resistance (PVR) [(PAP - PCWP) CO] 80 100-250 dynes-cm-sec-5 Estimated Blood Volume (EBV) Pulmonary vascular resistance index (PVRI) [(PAP - PCWP) CI] 80 45-225 dynes-cm-sec-5 Obese 60 ml/kg Premie 90-100 ml/kg Right ventricular stroke work index (RVSWI) 0.0136 (PAP - CVP) SI 5-9 g-mbeat-1m-2 Thin/Female 65 ml/kg Term 80-90 ml/kg Left ventricular stroke work index (LVSWI) 0.0136 (MAP - PCWP) SI 45-60 g-mbeat-1m-2 Adult Male 70 ml/kg < 1 Yr. 75-80 ml/kg Muscular 75 ml/kg 1-6 Yr. 70-75 ml/kg Abbreviations Respiratory Formulas Allowable Blood Loss = (Hctstarting- Hctallowable ) EBV/Hctstarting BSA Body surface area Variable/Equation Normal Values Volume To Transfuse = (Hctdesired- Hctpresent ) EBV/Hcttransfused blood BMR Basal Metabolic Rate Alveolar oxygen tension 110 mm Hg (FIO2 = 0.21) CaO2 Arterial oxygen content PAO2 = FIO2 (PB - PH2O) - PaCO2/0.8 Preoperative Medications (adult doses) CCO2 Pulmonary capillary O2 content Alveolar-arterial oxygen gradient Est Normal=(age/4)+6 < 10 mm Hg (FIO2 = 0.21) diazepam (Valium, Dizac) 5-20 mg PO, 2-10 mg IV CO Cardiac output A-aO2 = PAO2 - PaO2 < 60 mm Hg (FIO2 = 1.0) lorazepam (Ativan) 1-4 mg PO/IM/IV Mixed venous O2 content CvO 2 > 0.75 Arterial-to-alveolar oxygen ratio (a/A ratio) midazolam (Versed) 3-5 mg IM, 0.5-5 mg IV CVP Mean central venous pressure a/A ratio = PaO2/PAO2 temazepam (Restoril) 15-30 mg PO DO 2 Oxygen delivery Physiologic dead space as a fraction of TV 0.33 triazolam (Halcion) 0.125-0.5 mg PO Oxygen delivery index DO 2 I VD/VT = (PaCO2 - PECO 2 )/PaCO2 meperidine (Demerol) 50-150 mg IM/IV FIO2 Fraction inspired oxygen Arterial oxygen content 21 ml O2100 ml-1 morphine (Duramorph) 5-15 mg IM/IV HR Heart rate CaO2 = (Hb 1.36 SaO2/100) + PaO2(0.0031) atropine 0.4-0.8 mg PO/SQ/IV/IM MAP Mean arterial blood pressure Mixed venous oxygen content 15 ml O2100 ml-1 glycopyrrolate (Robinul) 0.1-0.3 mg IV/IM/SQ PB Barometric pressure (760mmHg) CvO2 = (Hb 1.36 SvO 2 /100) + PvO 2 (0.0031) scopolamine (Hyoscine ) 0.3-0.6 mg IV/IM/SQ PAP Mean pulmonary artery pressure Arterial-venous oxygen content difference 4-5.5 ml O2100 ml-1 haloperidol (Haldol) 1-2 mg IM/IV, 0.5 mg q8h PO PH2O H2O vapor tension (47mmHg) a - vO2 = CaO2 - CvO 2 secobarbital / pentobarbital 50-200 mg PO/IM PaCO2 Arterial CO2 tension Intrapulmonary (or physiologic) shunt fraction < 5% diphenhydramine (Benadryl) 25-50 mg PO/IM/IV Alveolar O2 tension Qs / Qt = (CCO2 - CaO2)/(CCO2- CvO 2 ) or P(A - a)O2 20 (For PaO2 > 175 and nl. CO) PAO2 hydroxyzine (Vistaril, Atarax) 25-100 mg PO/IM PaO2 Arterial O2 tension CCO2 = (Hb 1.36) + PAO2 (0.0031) (use FiO2 = 1.0) promethazine (Phenergan) 12.5-50 mg PO/PR/IM/IV Oxygen consumption or Fick eq. for CO 3.5 ml O2kg-1min-1 (@BMR) PCWP Pulmonary capillary wedge pres. metoclopramide (Reglan) 5-20 mg (0.1 mg/kg) PO/IM/IV PECO 2 Mixed expired CO2 tension VO2 = CO (CaO2 - CvO 2 ) 10 or CO = VO2 /(CaO2 - CvO 2 ) 10 cimetidine (Tagamet) 400 mg IM/IV, 400-800 mg PO PvO 2 Mixed venous O2 tension 110-140 mlmin-1m-2 VO2 I = CI (CaO2 - CvO 2 ) 10 famotidine (Pepcid ) 20-40 mg PO/IV Qs / Qt Intrapulmonary shunt fraction Oxygen delivery or transport ranitidine (Zantac) 150-300 mg PO, 50-100 IM/IV -1 SaO2 Arterial O2 Saturation % 1000 mlmin DO2 = CO (CaO2) 10 sodium citrate (Bicitra) 10-30 ml PO q2-4h Mixed Venous O2 Saturation % SvO 2 450-550 mlmin-1m-2 DO2I = CI (CaO2) 10 clonidine (Catapress) 2.5-5.0 g/kg PO VD Dead space gas volume Oxygen extraction ratio 22-30 % The author has exerted every effort to ensure that the drug dosages set forth in this reference are in accord with VT Tidal volume O2ER = ( VO2 / DO2 ) 100 or [(CaO2 - CvO 2 )/CaO2] 100 current recommendations at time of publication. The reader is urged to check the drug's package insert for any O2 consumption (minute) Copyright 19922002 by Jeffrey Cusick M.D. All rights reserved. May not be reproduced without VO 2 changes in indications or dosages as well as for warnings and precautionsespecially if the drug is new or O2 consumption index permission. Visit website http://www.accrs.com/ for references and ordering information. v2002.1 VO 2 I infrequently used. Always titrate drugs to effect. Ultimate responsibility is that of the prescribing physician. adenosine amiodarone atropine Debrillation 0.1 mg/kg 5 mg/kg IV/IO push 10-20 g/kg q5min 2 J/kg initial adenosine amiodarone
Amides Esters

Pediatric Code

Further dosing Indications Double and repeate dose if no effect. give over 20-60 min for tachycardia 1.0 mg max, minimum 0.1 mg. then 4 J/kg 2. Repeat after each med. 0.5-1 J/kg for cardioversion. 0.01 mg/kg q3-5min 0.1 ml/kg of 1:10,000. May 2nd+ dose. 0.5-1.0 g/kg 2-4 ml/kg of D25. Give slowly. 1 mg/kg may repeat 1 after 10 min. for torsdes de pointes or hypomagnesemia 25-50 mg/kg IV/IO 1 mEq/kg Use only with ventilation. Give slowly. 10-20 ml/kg isotonic (crystalloid).

Adult ACLS