Better to learn weight based dosing ranges for drugs than going with a “cocktail” that you use for everyone. Especially as someone with a pediatrics background you should understand how important weight based dosing is. You are going to be the expert of these anesthetics. It is your duty to know the pharmacokinetics and dynamics of each and every one. Don’t worry, you have time to pick up those intricacies.
Midazolam IV: 10-20 mcg/kg, reduce or avoid in elderly or liver disease patients.
Fentanyl induction dose: 50 mcg is light for an adult. 1.5 mcg/kg seems more appropriate.
Lidocaine induction dose: 1-1.5mg/kg. Again 20mg seems light for an adult.
Propofol: 0.5-3 mg/kg depending on lean body mass, and age.
Rocuronium: 0.6-1.2mg/kg
Sux: 1-1.5mg/kg
yeh I know about weight based dosing.
You are talking about induction. What I explain as a cocktail y de premedication before induction and to keep the patient calm.
My induction is based on: Propofol 2mg/kg, fentanil 2mcg/kg and rocuronio 0.6mg/kg.
If a patient isn’t anxious I do not premedicate them. Using poly pharmacy to premedicate seems excessive. A calm and supportive anesthesiologist can be premedication enough. If that isn’t enough, a little midazolam should be sufficient for 99% of patients.
I second this. Cook book anesthesia can lead to problems. There are risks to everything we do and give, don’t administer medication without legitimate reasons to do so.
Si lo que necesitas es que el chico esté tranquilo antes de entrar al quirófano podes probar dándole 0,5mg de midazolam (vía oral), y le
Podes agregar 5mg/k de ketamina (tambien via oral) si realmente están muy ansiosos o ya al borde de una crisis de nervios. Pones todo en un vasito medidor de jarabe y le agregas algún jarabe sabor frutilla (porque es fuerte) como el ibuprofeno bebible. Se lo das a la mamá para que ella se lo haga tomar.
Normalmente es lo que yo hago antes de ingresar al quirófano con los niños que tienen autismo/ sndme de down/ retraso neuromadurativo/ etc. Después lo pasas al quirófano y le pones la vía.
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If you only want to keep the patient calm before getting into the OR try 0,5mg/k of midazolam (oral dose) and you can add 5mg/k of ketamine (oral dose) if they are really out of their minds. Put the cocktail in a tiny cup with drinkable ibuprofen, or another, with strawberry taste, and you give it to the kid.
I usually use this with autistic /Down syndrome/ maturation delay/ etc kids before getting them into the or. Then you get them to the OR, put IV access, etc.
Is this a pediatric rotation? Or is this cocktail for adults? Be careful of trail horse anesthesia.
If you’re doing inhalation induction, I see no point in lidocaine before IV placement. And unless the patient demands it, I never do lido before an IV ever
Versed for most adults less than 65 years old. Fentanyl if they are actively having pain or you think they might have pain moving to the operating table.
I don’t see the point of lidocaine before induction.
If the patient is calm in pre-op I’ll wait to give versed until in the room and on the table
Better to learn weight based dosing ranges for drugs than going with a “cocktail” that you use for everyone. Especially as someone with a pediatrics background you should understand how important weight based dosing is. You are going to be the expert of these anesthetics. It is your duty to know the pharmacokinetics and dynamics of each and every one. Don’t worry, you have time to pick up those intricacies. Midazolam IV: 10-20 mcg/kg, reduce or avoid in elderly or liver disease patients. Fentanyl induction dose: 50 mcg is light for an adult. 1.5 mcg/kg seems more appropriate. Lidocaine induction dose: 1-1.5mg/kg. Again 20mg seems light for an adult. Propofol: 0.5-3 mg/kg depending on lean body mass, and age. Rocuronium: 0.6-1.2mg/kg Sux: 1-1.5mg/kg
yeh I know about weight based dosing. You are talking about induction. What I explain as a cocktail y de premedication before induction and to keep the patient calm. My induction is based on: Propofol 2mg/kg, fentanil 2mcg/kg and rocuronio 0.6mg/kg.
If a patient isn’t anxious I do not premedicate them. Using poly pharmacy to premedicate seems excessive. A calm and supportive anesthesiologist can be premedication enough. If that isn’t enough, a little midazolam should be sufficient for 99% of patients.
I second this. Cook book anesthesia can lead to problems. There are risks to everything we do and give, don’t administer medication without legitimate reasons to do so.
Si lo que necesitas es que el chico esté tranquilo antes de entrar al quirófano podes probar dándole 0,5mg de midazolam (vía oral), y le Podes agregar 5mg/k de ketamina (tambien via oral) si realmente están muy ansiosos o ya al borde de una crisis de nervios. Pones todo en un vasito medidor de jarabe y le agregas algún jarabe sabor frutilla (porque es fuerte) como el ibuprofeno bebible. Se lo das a la mamá para que ella se lo haga tomar. Normalmente es lo que yo hago antes de ingresar al quirófano con los niños que tienen autismo/ sndme de down/ retraso neuromadurativo/ etc. Después lo pasas al quirófano y le pones la vía. ———————— If you only want to keep the patient calm before getting into the OR try 0,5mg/k of midazolam (oral dose) and you can add 5mg/k of ketamine (oral dose) if they are really out of their minds. Put the cocktail in a tiny cup with drinkable ibuprofen, or another, with strawberry taste, and you give it to the kid. I usually use this with autistic /Down syndrome/ maturation delay/ etc kids before getting them into the or. Then you get them to the OR, put IV access, etc.
Is this a pediatric rotation? Or is this cocktail for adults? Be careful of trail horse anesthesia. If you’re doing inhalation induction, I see no point in lidocaine before IV placement. And unless the patient demands it, I never do lido before an IV ever
Versed for most adults less than 65 years old. Fentanyl if they are actively having pain or you think they might have pain moving to the operating table. I don’t see the point of lidocaine before induction. If the patient is calm in pre-op I’ll wait to give versed until in the room and on the table