Anesthesia Cart

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Anesthesia Cart
2015-09-22 21:09:57

Dental Anesthesia Cart
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  1. Cefazolin
    • Children: 50mg/kg
    • Adults: 1g
    • Beta Lactam Antibiotic: inhibit cell wall synthesis
    • Every 4 hours
    • 10% cross allergy w/ Penicillin
  2. Enlon Plus
    (Edrophonium + Atropine)
    • E: 10mg/ ml A: 0.14mg/ml
    • Dose: 0.1ml/kg (E:1mg/kg A:0.014mg/kg)
    • E (Cholinesterase Inhibitor/NMB reversal: Non-covalent bonding, rapid onset, short duration, indirectly increase ACh, causes bradycardia, bronchospasm
    • A (Anticholinergic): ACh competitive antagonist, tertiary-amine, ester linkage, crosses BBB, rapid acting, +++HR, ++Bronchodilation, +sedation, ++anti-sialagogue, reduces unwanted effects of E.
  3. Midazolam
    • Dose: 2mg
    • Benzodiazepam: GABAa allosteric modulator, Anticonvulsant, sedation, amnesia, anxiolysis, skeletal muscle relaxation, imidazole ring, liver biotransformation, active metabolite
    • SA: Minimal CV, - hypercapnia drive, - CRMO2, fatigue, drowsy (NO analgesia)
  4. Dexamethasone
    • Antiemetic: 0.1mg/kg (6mg)
    • Antiinflammatory: 1mg/kg
    • Glucocorticoid: Antiinflammatory, Tx cerebral edema, Tx PONV, lowest mineralcorticoid effect, 0.75mg equivalent dose to 20mg cortisol (25x more potent)
    • SA: + glucose (diabetic caution), inhibits wound healing
  5. Clindamycin
    • Adult: 600mg
    • Child: 20mg/kg
    • Lincosamide Antibiotic: Give over 30min, interfere w/ protein synthesis, narrow spectrum
    • SA: Pseudomembranous colitis, prolonged NMB, pre/post junctional effects @ NMJ.
  6. Ampicillin
    • Adult: 2g
    • Child: 50mg/kg
    • Penicillin-group antibiotic: Beta lactam, cell wall inhibitor
    • SA: Penicillin allergy leads to laryngeal edema, CV collapse, and bronchospasm, rash, nausea, diarrhea, inactivated by penicillinase.
  7. Ketorolac
    • Adult: 1mg/kg (30mg; 15mg in elderly)
    • Child: 0.5-1mg/kg
    • NSAID: Nonselective COX Inhibitor (+COX1), Analgesic, mild anti-inflammatory, platelet inhibitor, no ventilatory or cardiac depression, max effect in 45-60min
    • SA: Do not given w/ hepatic disease and caution in asthmatics. Long term may lead to GI and renal problems
  8. Epinephrine
    • Dose: 10mcg
    • Arrest: 1mg
    • EpiPen 300 mg (child 150mg) 
    • Non-selective Adrenergic Agonist: Emergency during arrest, asthmatic attack, bronchospasm, +CO, +HR, +MAP, - renal flow
  9. Cisatracurium
    • Dose: 0.1mg/kg
    • Non-depolarizing NMB (Benzylisoquinolone): Competitive ACh Antagonist, muscle relaxant, Hofman elimination, no histamine release, No BP/HR change, Increased block w/ hypokalemia/hypocalcemia/hypermagnesemia, Increased sensitivity w/ fewer AChR (myasthenia gravis), quaternary ammonium
    • SA: Laudanosine (metabolite of cisatracurium) toxicity (CNS excitation, +seizures, +MAC), Free acid precipitates w/ alkaline, potentiate acidosis,  Muscle denervation/increased AChR = lower response,
  10. Methylprednisolone
    • Vial: 125mg/2ml
    • Steroid (glucocorticoid + mineralcorticoid): Anti-inflammatory, 5x more potent than cortisol/hyrocortisone
    • SA: 1/2 Mineralocorticoid effect as cortisol
  11. Ephedrine
    • Dose: 5mg (titrate)
    • Mixed direct/indirect adrenergic agonist: +NE secretion, temporary vasopressor, less potent and longer lasting than epic, +HR, +MAP, +CO, +SVR, bronchodilation, some direct effects
    • SA: Tachyphlaxis, will not work with depleted catecholamine stores
  12. Diphenhydramine
    • Adult: 0.5-1mg/kg (Child 0.5mg/kg)
    • H1 Antihistamine (Ethanolamine): Suppresses allergic rxn, prevent bronchoconstriction, antiemetic, antinausea, tx hypoention, can potentiate other CNS depressants (barbs, benzos, opioid), pre-tx for meperidine/morphine (histamine release)
    • SA: Ineffective against asthma
  13. Phenylephrine
    • Dose: 100mcg (titrate)
    • Alpha 1 Agonist: +SVR, +BP, 
    • SA: reflex bradycardia, - renal blood flow, no CNS effects, serial dilution (2) needed
  14. Terbutaline
    • Dose: 0.25mg SubQ
    • Beta 2 Agonist: Tx Asthma attack, tx COPD
    • SA: tachycardia due to B2 on heart (act like B1)
  15. Magnesium-sulfate
    • Dose: 50mg/kg (titrate)
    • Electrolyte: Tx of tornadoes, + systemic/coronary vasodilation, - platelet aggregation, - myocardial reperfusion injury
  16. Vasopressin
    (Anti-Diuretic Hormone)
    • Dose: 1 unit (titrate); 40 units in cardiac arrest
    • Antidiuretic Hormone: Tx refractory hypotension (ACE & ARB induced), Tx diabetes insipidus, hemodynamic stabilization, peripheral vasoconstriction, ADH made in posterior pituitary, + H2O absorption in collecting ducts
    • SA: Vasoconstriction of coronary arteries, GI stimulation & pain
  17. Amiodarone
    • Dose: 150mg
    • Class III Anti-arrhythmic (Class I,II & IV effects): Block K channels which Increase refractory period/prolong AP duration&depolarization, Tx refractory VT & SVT, WPW tachydysrhtthmias, noncompetitive alpha and beta blocker, vasodilate coronary arteries, works on SA/AV nodes, atria, ventricles, His-purkinje, & accessory tracts
    • SA: Pneumonitis, may prolong QT, decrease catecholamine response
  18. Hydralazine
    • Dose: 5mg (titrate)
    • Nitrovasodilator: HTN, relaxes arteriolar smooth muscle, cerebral vasodilation, inhibits cerebral autoregulation, + cGMP to increase NO, 15min onset, 2-4h duration
    • SA: reflex tachycardia, + contractility/CO detrmintal to CAD pts (minimize risk w/ B-blocker)
  19. Adenosine
    • Dose: 6mg followed by 20ml saline bolus
    • Adenosine-1 Agonist (nucleoside): Tx SVT and WPW, slows conduction through AV node, blocks acute nociception, decreases thermal and mechanical hypersensitivity, + K current and increased repolarization time, Cardiac effects similar to Ca channel blockers
    • SA: Transient AV Block, bronchospasm, facial flushing, dyspnea, headache, does NOT affect AFib, AFlutter, or ventricular arrhythmias
  20. Atropine
    • Dose: 0.4mg (severe bradycardia: 1mg)
    • Dose: 0.01-0.02mg/kg up to 0.4/0.6mg
    • Anti-cholinergic: +HR, +bronchodilation tx bradyarrhythmias, tx bronchocontriction, anti-sialogogue, tertiary amine, ester linkage, cross BBB, rapid onset, short duration, competitive antagonist
    • SA: CAD may not tolerate +O2 demand and - O2 supply. Caution w/narrow angle glaucoma, posterity hypertrophy, bladder neck obstruction
  21. Hydrocortisone/Cortisol
    • Stress Dose: 100mg
    • Cortisol: Exogenous steroid for adrenally suppressed (Addison's, chemo), anti-inflammatory, allergy tx, anti-emetic, asthmatic tx, Rule of 2s: 20mg cortisol, 2weeks, 2years (1yr), zona fasciculata, stimulate changes in protein synthesis
    • SA: increase glucose (contra in diabetics), decreased wound healing, Buffalo hump, moon faicies
  22. Fentanyl
    • Dose: 1mcg/kg
    • Opioid Agonist (Mu): Analgesic, decrease response to surgery, sedation, NO AMNESIA, decreases response to ACh, substance P, & glutamate, liver biotransformation, 
    • SA: Vagus nerve mediated bradycardia, increase apnea threshold, decreased respiration, chest wall rigidity, induced hyperalgesia
  23. Dextrose
    • 500mg/ml
    • 50% Dextrose: For hypoglycemia (50ml in diabetics), metabolic disorders (sepsis, infection, malignant hyperthermia)
  24. Sevoflurane
    • MAC: 2.0%
    • B/G: 0.65
    • Increases non-depolarizing NMB, non-pungency and rapid increases make it a good choice for induction, may prolong QT interval, compound A is a nephrotic end product
    • Contra: Hx of Malignant hyperthermia, intracranial HTN, severe hypovolemia
    • Stats: -BP,SVR,&CO, -TV, +RR, +CBR&ICP, --CMRO2, -GRF&RBF 
    • Metabolism: 5% hepatic P450,
  25. Isoflurane
    • MAC: 1.15%
    • B/G: 1.4
    • Dilates coronary arteries, low levels blunt the response to hypoxia and hypercapnia, increases non-depolarizing NMB, 
    • Contra: History of malignant hyperthermia, pts with severe hypovolemia
    • Stats: --BP&SVR, +HR, --TV, +RR, +CBF&ICP, --CMRO2, --RBF, GFR, 
    • Metabolism: 0.2% hepatic
  26. Desflurane
    • MAC: 6.0%
    • B/G: 0.42
    • Low solubility causes rapid induction and emergence; rapid increases lead to transient increases in HR, BP, and catecholamines; depress hypercapnic ventilatory response; degraded by absorbent into carbon monoxide which may cause poisoning; increase effects of non depolarizing NMB
    • Contra: Severe hypovolemia, malignant hyperthermia, and intracranial HTN
    • Stats: --BP, --SVR, HR/CO stable, -TV, +RR, ++PaCO2, -GRF, -RBF
    • Metabolism: <0.1% hepatic
  27. Nitrous Oxide
    • NMDA Receptor Antagonist
    • MAC: 103
    • B/G: 0.47
    • Stimulates sympathetic NS: +HR,+RR,-TV,+ICP,-RBF,+PONV
    • SAs: Prolonged exposure can result in bone marrow depression (megaloblastic anemia) and neurological deficiencies (peripheral neuropathies); increases pulmonary vascular resistance; avoid in pregnant (1st/2nd) patients
    • Contraindicated:venous or arterial air embolism, pneumothorax, acute intestinal obstruction, intracranial air, pulmonary air cysts, intraocular air bubbles, and tympanic membrane graft
  28. Sucinylcholine
    • Dose: 1mg/kg
    • Depolarizing NMB: Muscle relaxant, rapid onset, short duration, Phase I&II, rapid sequence induction, fasciculation signals onset, no reversal in phase I, histamine release, Structure is 2ACh molecules connected
    • SA: Prolonged action with atypical psueocholinesterase (dibucaine #80>40-60>20) , causes hyperkalemia (0.5mEq/L), increased risk for rhabdomyolysis and cardiac arrest, may cause muscle pain, increased intragastric pressure, masseter muscle rigidity
    • DO NOT ADMIN: children, burn injury over 1 week, massive trauma, neurologic disorder, Hx of malignant hyperthermia, hyperkalemic,
  29. Labetalol
    • Dose: 5mg (titrate)
    • Beta1, Beta2, Alpha1 Blocker: Lower BP w/o reflex tachycardia, useful w/ CAD, manage chronic heart failure secondary to cardiomyopathy & LV dysfunction, Tx HTN, no change in CO, tx rebound HTN, 7x more Beta, peak effect @ 5min, carvedilol is also mixed
    • SA: orthostatic hypotension, increase bronchospasm, fluid retention, prolonged w/ liver disease
  30. Flumazenil
    • Dose: 0.1mg (titrate)
    • Benzodiazepine competitive antagonist: Reversal of benzo sedation + overdose (amnesia less reliably prevented), hepatic metabolism
    • SA: Rapid admin may cause anxiety, Increase ICP, may induce seizures, CO2 depression may linger
  31. Naloxone
    • Dose: 0.04mg (titrate)
    • Opioid Antagonist (all receptors): Tx opioid OD, Antagonize anti-HTN of clonidine, liver metabolism, 30-45 min duration, shorter duration than opioid
    • SA: Abrupt admin leads to sympathetic stimulation due to pain (tachycardia, HTN, pulmonary edema, ventricular irritability) and increased PONV,
  32. Neostigmine
    • Dose: 0.07mg/kg (5mg max) 
    • Give w/glycopyrrolate: 0.2mg/mg Neostigmine 
    • Cholinesterase Inhibitor: Reverse non-depolarizing NMB or phase II depolarizing block, covalent binding to ACh-ase, given w/ glycopyrrolate, indirectly increase ACh, carbamate+quaternary ammonium, 10min peak effect, 1hr duration
    • SA: Excessive doses can potentiate NMB, Prolong phase I succinylcholine block, bradycardia, GI spasm, bronchospasm, PONV
  33. Glycopyrrolate
    • Dose: 0.005-0.01mg/kg up to 0.2mg.
    • Dose w/ Neostigmine: 0.2mg/mg Neostigmine, 
    • Anticholinergic: competitive antagonist, 
    • SA: ++ Tachycardia, ++bronchodilation, no sedation, +++anti-sialogogue, quaternary ammonium, ester linkage, cannot cross BBB, 2-4hr duration, slower onset vs atropine
  34. Nicardipine
    • Dose: 1mcg/kg/min
    • Ca Channel Blocker (Dihydropyridine): Potent vasodilator (especially coronary a.), used w/ B-Blocker for angina, useful for HTN pts despite B-Blocker, prevents Ca into vascular smooth m. decrease BP, increase coronary and peripheral vasodilation
  35. Lidocaine
    • Dose: 1mg/kg
    • Na Channel Blocker (amide): Blunt sympathetic response, reduce post-op pain, decrease opioid dose, Class IB anti-arrhythmic for ventricular tachycardia, blunt pain of injection
    • SA: not for children due to toxicity, Do not tx in pts with:heart block, SA block, WPW syndrome. Depresses hypoxic drive, P450 metabolism
  36. Ondansetron 
    • Dose: 0.1mg/kg (4mg to 8mg)
    • 5HT3 Serotonin Receptor Antagonist: Tx PONV, chemoreceptor trigger zone in area postrema of brain (no BBB) and GI receptors, free of neurologic effects, 30-60min onset, antipruritic
    • SA; may prolong QT, headache, diarrhea, extensive liver metabolism
  37. Propofol
    • Adult: 2mg/kg (Child: 3mg/kg)
    • GABAa allosteric modulator: GA induction, sedation, anticonvulsant, antiemetic, antipruritic, NO direct analgesia or amnesia
    • SA: Decreased BP due to sympathetic block, negative inotropy, Propofol infusion syndrome, inhibit sympathetic response, profound respiratory depression, decrease hypercapnia response, soybean-oil+glycerol+ egg-lecithin emulsion, use within 6-12h, hepatic metabolism + kidney excretion
  38. Vecuronium
    • Dose: 0.1mg/kg
    • Non-depolarizing NMB (steroidal): Competitive ACh antagonist, ++onset, ++ duration, no significant CV effects, equipotent w/ pancuronium
    • SA: increased block w/ 3-hydroxymetabolite accumulation, polyneuropathy, increased dose need for liver disease due to increased volume
  39. Furosemide
    • Dose: 5mg (1-2mg urination)
    • Loop Diuretic: Tx severe essential HTN, edema from CHF, renal&hepatic failure, Increased ICP. Inhibit Ca cellular uptake to tx hypercalcemia, works on ascending loop, inhibits NaCl reabsorption
    • SA: acute hypovolemia, exacerbate renal ischemic disease, acute tolerance, cross allergy w/ sulfonamide, causes hypokalemia (often need K supplement)
  40. Metoprolol
    • Dose: 5mg (titrate)
    • Beta1 Blocker: Decrease HR, preferred for COPD/asthma or peripheral vascular disease, decrease AV conduction, great for pts w/ hypoglycemia, hepatic metabolism, no ISA
  41. Albuterol
    • 90mcg/puff
    • Beta 2 Agonist: Bronchodilator, for asthmatics and COPD, peak effect 30-60min
  42. Esmolol
    • Dose: 10mg (titrate)
    • Beta 1 Blocker (Class II anti-arrhythmic): Prevent tachydardia + HTN, control ventricular rate w/ Afib & Aflutter, ultrashort acting, rapid onset, plasma esterase metabolism
    • SA: avoid w/ sinus bradycardia, heart block over 1st degree, cariogenic shock, and heart failure
  43. Dantrolene
    • Dose: 2.5mg/kg every 5 min (max 10mg/kg)
    • Ca Channel Blocker: Ryanodine1 receptor antagonist
    • Direct acting skeletal muscle relaxant, Given following malignant hyperthermia, may be given after MAOI overdose, cannot achieve the same level of relaxation as NMBs, therapeutic levels do not affect cardiac or smooth muscles
  44. Etomidate
    • Induction Dose: 0.2-0.5mg/kg
    • Mimics GABA and depress RAS
    • Metabolism: hepatic microsomal enzymes and plasma esterases
    • CV: minimal effects. Slight decrease in vascular resistance
    • Resp: Small effects on ventilation unless opioid have been administered. 
    • Cerebral: Decreases CMRO2, CBV, and ICP. CPP well maintained. PONV is common
    • Endocrine: Inhibit enzymes producing cortisol and aldosterone and long term use can cause adrenocortical suppression
  45. Ketamine
    • Induction Dose (IV): 1-2mg/kg
    • Induction Dose (IM): 3-5mg/kg
    • NMDA antagonist: Dissociates the thalamus from the RAS, Analgesia, amnesia, and unconsciousness. Adrenergic antagonists unmask the direct myocardial depressive effects.
    • Metabolism: Norketamine retains anesthetic activity and has a high hepatic uptake. 
    • CV: Increases BP, HR, and CO due to stimulation of sympathetic and inhibition of NE repuptake. Direct myocardial depressant effect
    • Respiratory: mild decrease in ventilatory drive with bronchodilation, upper airway reflexes remain intact
    • Cerebral: increases CMRO2, CBV, and ICP
  46. Rocuronium
    • Intubating: 0.6mg/kg
    • Rapid Sequence: 1.2mg/kg
    • Non-depolarizing muscle relaxant: Competitive antagonist at the ACh receptors.