0071643192.pdf

PROCEDURES AND SKILLS

TABLE 19.3. Drug Characteristics Used in Procedural Sedation

DRUG ONSETTIME DURATION ADVERSEEFFECTS NOTES

Versed 3 min IV 30 min IV Paradoxical hyperexcitability Hypotension

Children:0.1 mg/kg IV in children

Adults: 0.03–0.1 mg/kg IV Apnea Can reverse with

Hypotension flumazenil

Propofol 30–45 s IV 20–75 min IV Apnea

1 mg/kg IV Hypotension

Bronchospasm

Etomidate 30–60 s IV 3–5 min IV Myoclonus, adrenal suppression Can cause myoclonus

0.1–0.3 mg/kg IV with multiple doses or laryngospasm

Methohexital 1 min IV 15 min IV Apnea

1–2 mg/kg IV Hypotension

Ketamine 1 min IV 10–20 min IV Laryngospasm, emergence Give atropine or glyco-

Children: 1–2 mg/kg IV; 5 min IM 15–45 min IM reaction, increased ICP, pyrrolate to suppress

2–4 mg/kg IM hypersalivation hypersalivation,

benzodiazepines to

prevent emergence

reaction or cardiovascular

instability

Fentanyl 3 min IV 30 min IV Apnea Can reverse with

1–1.5 μg/kg IV naloxone, nalmefene

Atropine 30–60 s IV 2 hours Tachycardia Use in children <5 year-old

Children: 0.01 mg/kg 5 min IM Anticholinergic symptoms to counteract vagal effects

IM or IV Min 0.1 mg of ketamine

Max 0.5 mg

Glycopyrrolate 1 min IV 2–7 hours Tachycardia Use in children <5 year-old

0.004 mg/kg IV/IM 15–30 min IM Anticholinergic symptoms to counteract vagal effects

of ketamine

Flumazenil <30 s IV 30–60 min IV Unmasking of seizures

Children: 0.01 mg/kg IV

Adults: 0.2 mg IV

Naloxone 1–2 min IV 1–4 hours May precipitate withdrawal May require repeat

Children: 0.01 mg/kg IV 2–5 min IM reactions dosing due to short

Adults: 0.4–2 mg IV/IM duration