Anesthesia Ref Card

Anesthesia Reference Card Inhaled Agents

Intravenous Anesthetics Induction Maintenance Sedation mg/kg µg/kg/min µg/kg/min 1.5-2.5 100 - 250 50 - 200 Propofol 3-5 50 - 100 30 – 70 Thiopental 0.2-0.4 Etomidate 10 - 100 10 – 50 1-2 (4-8 Ketamine

MAC

Desflurane Sevoflurane Isoflurane Enflurane Halothane

IM)

Nitrous Oxide

Methohexital 1-2 0.1-0.3 0.25 - 1 Midazolam 0.05 – 0.5 5-20 µg/kg Fentanyl 0.01 – 0.1 2-10 µg/kg Sufentanil Neuromuscular Blocking Drugs 1-2 Succinylcholine 0.6-1 10-15 Rocuronium 0.2 1-2 Vecuronium 0.2 1-3 Cisatracurium 0.3-0.4 5-15 Mivacurium 0.1 1-15 Pancuronium NMB Reversal Cholinesterase Dose Anticholinergic Inhibitor mg/kg Cardiovascular Drugs 0.05 Gycopyrrolate Neostigmine Pressors 0.5-1 Atropine Edrophonium

Phenylephrine Ephedrine Dopamine dopa

50-200 µg 5-20 mg -

β α+β

Dobutamine Epinephrine β

Bupiv Ropiv Lido Procain Tetraca

ED95 µg 300 50 50 80 70

Dose mg/kg 0.01 0.0CV 2

T10 6-10 6-10 25 75 6-10

6-7 2 1.2

0.42 0.69 1.5

1.3 1.7 1.6

669 160 240

1.6 0.75 105

1.9 2.5 0.46

1.5 1.9 1.1

172 244

T6 8-14 8-14 50-75 125 8-14

Sufenta 500mg + Midaz 15mg + Roc 200mg Mix in 500ml NS and run at 1ml/kg/hr Sufenta 500mg + Midaz 20mg + Roc 160mg Mix in 50ml NS and infuse at 10-13 mAdrenergic l/hr (0.1 ml/kg/hr) Activity

Duration HR CO SVR Ind α β Infusion 1 1 β2 µg/kg/min min Act ++ 0.1-0.75 1-8 ↓ ~↓ ↑

1-10 5-10

↑ ~

↑ ↑

↑ ~↓

Χ

++ 0

++

+

3 – 10 10 - 20 2 - 20 5 0.05-0.1 5-10 0.1 - 1 5-10

↑ ↑↑ ~↑ ↑ ↑↑

↑↑ ↑↓ ↑ ↑ ↑↓

↓ ↑ ~↓ ~ ↑↑

Χ Χ

+ ++ 0 + ++

+ ++ ++ ++ ++

++ + + ++ ++

↓ ↑↑

~ ↑↑

↑↑ ↓↓

++

++ ++

++

↓ ↑

-

1-3

2-10 µg α + β up to 1 mg 0.05-0.5 1-10 Norepinephine 20-60 µg 0.01-0.5 1-5 Isoproterinol

Beta Blockers Esmolol Labetalol Metoprolol

10-30 mg

50-300

5-10

↓

↓

5-15 mg 2-15 mg

2

5-90 1-8

~↓ ↓

~↓ ↓

---

Dur w/ epi 120-150 140 60-90 60-75 120-180

Plain 150(2) 200 300(4) 500 100

With Epi 240(3) 500(7) 600 200

Lumbar Epidural

PFMS

Proced

Atropine Lidocaine Isoproterinol Epinephrine Naloxone Vasopressin Valium

Local Max Dose

Duration 90-120 90 45-60 30-45 60-90

Intrathecal

Pump in a bag/syringe

Effects

T4 12-20 12-16 75-100 200 12-20

ALIEN V2

Vapor Press

Spinal Block units are mg or min

Intubating Maintenance dose mg/kg mg/kg/min

Bolus IV

ETT Drugs

Blood:Gas Brain:Blood Coeff Coeff

Pelvic

0.3-0.4 Hip/Knee/Abd 0.4-0.5 0.5-0.6 High Abd Nephrec/CCX 0.6-0.7 AAA/Thorac 0.7-0.8

Proced

PFMS

Pelvic Abdom Thoracic

4 mg 6 mg 8 mg

Epidural Infusion PFMS 20 mg + Bupiv 200 mg in 200 ml NS Fentanyl 2 mg + Bupiv 200 mg in 200 ml NS Pelvic-4 ml/hr, Abd-6 ml/hr, Thorac-8 ml/hr

PCA Dosing Breakthrough MS 1-2 mg q 20 min; 4 hr max 10 mg Demerol 10-20 mg q 20 min; 4hr max 100 mg Full Strength MS 1-2 mg q 10 min; 4 hr max 30 mg Demerol 10-20 mg q 10 min; 4hr max 300 mg

Narcan Dosing For Respiratory Depression, N/V, Pruritis Bolus: 0.08-0.2mg then infuse at 0.2-0.3 mg/hr 1.6 mg into 250 ml NS; run at 30-50 ml/hr

Misc Flumazenil: 0.2 mg q 1 min to max 1mg Dopram: 0.5-1.5 mg/kg q 5 min max 2mg/kg Physostigmine: 0.5-1 mg q 15 min max 3 mg

-

hr

Parenteral Analgesia

Calcium Channel Blockers Nicardipine Nifedipine Diltiazem Verapamil

0.5-2

5-15

10 mg SL

5-30

↑

↑

↓↓

↑

↓↓

↓

5-20 mg 2.5-10 mg

2-60

↓

↓↓ ↓

↓↓

Vasodilators Nitroglycerine Nitroprusside Hydralazine

50-100 µg 50-100 µg 5-10 mg

0.2-10

1-5

↑

↓

↓

0.2-10

1-10

↑

~↑

↓↓

1-4

↑

~↑

↓

hr

Trimethaphan

1-20 mg

5-10

↓

Potency

1 Morphine 0.1 Demerol 7 Dilaudid 10 Alfentanil 100 Fentanyl 750 Sufentanil 250 Remifent 5 Stadol 9 (30mg) Toradol

Peak (min)

Duration (hr)

Dose IV (mg)

5-20 5-20 5-20

2-4 2-4 2-4

1-10 10-100 0.5-2

1-2 5-10 3-5 1-2 5-10

0.25 0.5-1 0.5-1 0.2 2-4 3-7

30-60

0.25-0.5 25-100 µg 10-30 µg

0.5-2 30-60

Pediatric Anesthesia Reference Card Endotracheal Tube Diameter Age

Diameter 3 mm

Neonate 3.5 mm 4 mo 4 mm 12 mo 3.5 + Age/4 > 1 yr Lip to Mid-Trac. Dist Wt/Age

1 kg 2 kg 3 kg 6 mo 12 mo >1 yr

Length 7 cm 8 cm 9 cm 10 cm

Weight

Cuff vol

Drug

1 1.5 2 2.5 3

<5 kg

3 ml

Midazolam

5-10 kg

7 ml

10-20 kg

10 ml

T10, Hernia T5, Orchido Age

Preterm Neonate 6 month 1 year 4 year

20 ml

Reg feed

Clears

Neonate 4-18 mo >18 mo

4 hr

2 hr

6hr

3 hr

8 hr

3 hr

Est. Blood Vol. Age Not+Loc

Vol Local

MS 40µg/kg 0.5 ml/kg 0.75 ml/kg 50µg/kg 1 ml/kg

14 ml

>30 kg

Age

12 cm

Caudal

20-30 kg

NPO Guide

12 + Age/2

Proc Perineal

Pre-Op Meds

LMA Sizing Size

70µg/kg

Diameter

Neonate 85 ml/kg 1-4 yr 75 ml/kg >5 yr 65 ml/kg Allowable Blood Loss 0.8 * wt(kg) * (Htc-30) Give 1 mg Ca per ml Blood

Normal Values HR 150

BP PaO2 Hb Wt (kg) 50/30 70 18-22 <3

140

60/40

70

18-22

135

85/60

85

12

7

130

90/60

85

11

100

95/65

90

13

10 (Age-1)*2 + 10

3-4

Dose 0.5 mg/kg PO 15 mg max 0.2 mg/kg IM 0.02-0.1 mg/kg IV

Ketamine Cimetadine Clonidine

3-6 mg/kg IM (induct) 5-7.5 mg/kg PO 5 µg/kg PO

Parenteral Analgesia Drug

Misc Meds Drug

Dose

Ondansetron Flumazenil Naloxone Physostigmine Doxapram Reglan Droperidol

0.1-0.15 mg/kg 10-30 µg/kg 1-4 µg/kg 30 µg/kg 0.5-1.5 mg/kg 0.15 mg/kg PO

Dose

Ketorolac 0.5-1 mg/kg Butorphanol 5-10 µg/kg, may repeat X2 Nalbuphine 0.1-0.3 mg/kg Morphine 0.025-0.1 mg/kg Meperidine 0.25-1 mg/kg Opioid Maintenance

5-25 µg/kg

Emergency Drugs Drug

Dose

Phenylephrine 1-10 µg/kg Epinephrine 10 µg/kg Ephedrine 0.1 mg/kg Na Bicarb 0.3*Bdef*kg/2 Ca Gluconate 30-60 mg/kg Agent Load µg/kg Maint µg/kg/hr Adenosine 50-200 µg/kg 2-10 3-10 Fentanyl Lidocaine 0.5-3 0.5-1 Sufentanil 1 mg/kg 50-250 25-150 Esmolol Alfentanil 500 µg/kg 1 0.2-1 µg/kg/min Remifentanil Atropine 20 µg/kg Blood Gas Guide Metabolic Acidosis pCO2 falls by 1 – 1.5 fall in HCO3 ↓CO2↓ pH Metabolic Alkylosis pCO2 rises by .25 – 1 rise in HCO3 ↑CO2 ↑ pH pH dec 0.08 HCO3 ↑ 1 mEq for ea 10 mmHg ↑ in CO2 Acute Resp Acidosis for ea 10mm Chronic Resp Acidosis HCO3 ↑ 3 mEq for ea 10 mmHg ↑ in CO2 inc in pCO2 Acute Resp Alkylosis HCO3 ↓ 2 mEq for ea 10 mmHg ↓ in CO2 pH inc 0.08 for ea 10mm Chronic Resp Alkylosis HCO3 ↓ 5 mEq for ea 10 mmHg ↓ in CO2 dec in pCO2

Riley ICU Anesthesia Reference Card Pain & Sedation Options Dexmetedom 0.2-0.7 mcg/kg/hr .25-.5 mg/kg/dose Ketamine 2-3 mcg/kg/hr >5 ask staff Fentanyl 25-50 mcg/kg/hr MSO4 .05-.1 mg/kg / q 2hr PRN MSO4 5 – 30 mcg/kg/ q1 - 3 hr Stadol 20 – 50 mcg/kg q 1-2 hr PRN Versed avoid drips 50 mcg/kg/dose q 4-6 hrs PRN Ativan .05-.1 mg/kg/dose Valium 15-30mg/kg PO or PR q 8 hr Chloral hypnotic 20-50 mg/kg Hydrate max dose 1gm 2gm/24 hr .5mg/kg/dose ask staff Thorazine .25 - .5mg /kg /dose 30” – 60” Ketamine Benadryl | .5mg/kg/dose Consider hypoxia, hypercarbia, ptx, effusion, hypoglycemia, hyponatremia, short term paralysis (staff approval)

Respiratory Therapy Options .5cc in 2.5 cc NS q 4-6 h Racemic Epi 2.25% .5cc in 2.5 cc NS Atrovent .02% .5mg in 2.5cc NS q 4-6 h NaHCO3 4.2% ¼ str Newborn lavage q 4-6 h NaHCO3 8.4% ¼ str Lavage q 4 – 6 h Mucomyst 5% - 10% q 6 h w/ventolin .2 -.3 cc in 2 cc NS Alupent Heliox Tx 40% Hut Albuterol neb .5%

Acute Pain Service < 1 yr admit to ICU PCA for >20 kg <6yrs consider intellect MSO4 1 mg/cc (Low range for ¼ strength p neurax MS) Load dose .050-.15mg/kg Inc dose 25-40 mcg/kg lockout 10-20 min (5-99 possible) 4 hr max 150 mcg/kg (1st 12 hr ) - 250 mcg/kg Toradol .5mg/kg q 6 hr (max 30 mg) 5 days ?ortho – OK? Valium (muscle spasm) 2mg PO q 8hr X 48hr PO drugs Adjuncts to Pain Control Tylenol 3 Tylenol 10-15mg/kg/dose Codeine .5-1 mg/kg/dose Elixer Tablet

Tylenol Codeine Tylenol Codeine

Side Effect Therapy Compazine >10kg >2yo Reglan Zofran Benadryl Valium (muscle spasm) Naloxone IV Naloxone gtt Nubaine IV

120 mg/tsp 12 mg/tsp (5cc) 300mg 30 (10%)

.1mg PO,PR 6-8hr 60-100 mcg/kg .1-.15 mg/kg IV 1mg/kg PO .5mg IV 2mg PO q 8hr X 48hr 1 mcg/kg 5 mcg/kg/hr (6.4 mcg/cc) 50 mcg/kg /dose

Staff Pagers Bennie

212-1051

Emhardt

212-1060

Green

212-1063

Hardacker

212-1065

Hillier

212-1069

Kelly Krishna

212-7151 212-1071

Lathem

212-1052

Mazurek

212-1096

McNiece Means Presson

212-1075 212-1076 212-1081

Rao Sheplock

212-1082 212-1084

Stasic Stoelting Tolley

212-1085 212-1086 212-1097

Walker

212-1091

Wolfe Patti

212-1093 274-9981

Other Numbers Main OR 4-8222 PACU

4-9945

Workroom

4-9978

Burn Unit ICU SE

4-3927 4-6066

ICU SW

4-0243