5-157
associated with inadequate depth of anesthesia. With inadequate levels of anesthesia, patients may recall
later what happened in surgery.
Table 5-11: Pre-And Intraoperative System Checks For Continuous Infusion
Preoperative checks
- Medication infusion lines “piggybacked” into established IV line.
- Medication infusion lines are primed and purged of air.
- Clips and clamps have been removed from medication infusion lines.
- If electrical infusion devices are available:
- Functional and in the “ON” position.
- Dosage settings are correct.
- Connected to a reliable electrical supply.
Intraoperative checks
- Medication lines remain connected to carrier fluid.
- Carrier fluid is present and flowing.
- Pump alarms remain active.
- Drug supply in reservoir is adequate.
Table 5-12: Examples of Techniques Used In The Field:
Example 1.
Continuous infusion of midazolam, ketamine, and vecuronium.
Induction: midazolam (1 mg/kg), followed by ketamine (2 mg/kg) and vecuronium 0.1 mg/kg. Following
intubation, initiate infusion of the same medications at the following rates:
Midazolam (50 mcg/kg/hr),
Ketamine (1 mg/kg/hr)
Vecuronium (60 mcg/kg/hr)
Obtain this infusion mixture by adding midazolam 5 mg, ketamine 100 mg and vecuronium 6 mg to a 50 ml
bag of 0.9% normal saline and infuse at the rates mentioned above. Determine the infusion rate to deliver
this concentration by using the formula:
Patient’s weight (kg) = ml to be infused per hour
2
So that a patient weighing 70 kg would require an infusion rate of 35 ml/hr.
Sample Calculations:
- Midazolam infusion of 50 mcg/kg/hr, means 50 mcg x 70 kg or 3500 mcg/hr is required.
- Using the formula:
Patient’s weight (kg) = ml to be infused per hour or 70/2 = 35 ml/hr to be infused for this patient
2
Therefore, 3500 mcg/hr required divided by 35 ml/hr (determined infusion rate) yields a concentration
requirement of 100 mcg/ml.
- Adding 5 mg of midazolam to 50 ml of 0.9% normal saline yields a concentration of 100 mcg/ml
Similar calculations yield requirements for 100 mg of ketamine and 6 mg of vecuronium.