Special Operations Forces Medical Handbook

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

1. Medication infusion lines “piggybacked” into established IV line.


2. Medication infusion lines are primed and purged of air.


3. Clips and clamps have been removed from medication infusion lines.


4. If electrical infusion devices are available:

• Functional and in the “ON” position.


• Dosage settings are correct.


• Connected to a reliable electrical supply.
  Intraoperative checks

1. Medication lines remain connected to carrier fluid.


2. Carrier fluid is present and flowing.


3. Pump alarms remain active.


4. 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:

1. Midazolam infusion of 50 mcg/kg/hr, means 50 mcg x 70 kg or 3500 mcg/hr is required.


2. 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.

3. 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.