anesthesia drugs
Drugs
Anticholinesterases- reversal agents for blocking agents (NBMR)
Drugs
Dose mg/ Kg
Onset
Duration
Facts
Edrophonium. Give glycol b/f otherwise you see bradyacardia- don’t mix! 7 micro grams/ Kg atropine. May need more (10-15 microg/ Kg) if given with opioid- based anesthetic.
0.5-1.5 (usual dose 40-70 mg)
Approx equivalent dose- 35 mg
1-2 min
60 min
Less effective than neo for deep block
Neostigmine
20 mcg/kg atropine (more rapid than neo). 10 microg/ Kg glycopyrrolate (parallels onset of neo). Draw glycol up second (b/c we use it all). But put neo and glycol together and give together to avoid tachycardia.
0.035-0.07 (usual 3-4 mg). Equivalent dose- 3 mg
7-11 min
54 min
Max dose 5 mg. Give for more intense block. Not as good in renal pts. Give for more intense block. Mild hypothermia (34-35 C) decreases clearance, & onset/ peak are delayed
Pyridostigmine 20 micrograms/ Kg atropine (onset receded pyridostigmine). 10 microg/ Kg glycopyrrolate (onset precedes pyrido.)
0.1-0.35 (usual 10-20). Equivalent dose 15 mg
16 min
76 min
Can contribute to post op N/V . Neo is dose related N/V
Reversal decreases incidence of paralysis/ weakness
Neostigmine 3mg with Robinul (glycopyrrolate) .6 mg (5:1)
Neostigmine 3mg with Robinul .4mg (7.5:1)
Muscarinic Antagonists
Give preop for oral and airway secretion reduction, and in peds to prevent bradycardia.
Treatment of reflex-mediated bradycardia
Prevention of motion N?V
Give with anticholinesterase to antagonize NDMR- not mandatory
Placental crossing doesn’t change baby HR
For sedation, give Scopolamine b/c 100 times more potent than atropine for decreasing reticular activating system activity (part of the brain that wakes you up). Enhances benzos and opioids. Volatiles can potentiate anticholinergic drugs on CNS (restlessness and somnolence).
Physostigmine can reverse effects (15-60 micrograms/kg IV).
Central anticholinergic syndrome- usually caused by scopolamine, can be
Anticholinesterases- reversal agents for blocking agents (NBMR)
Drugs
Dose mg/ Kg
Onset
Duration
Facts
Edrophonium. Give glycol b/f otherwise you see bradyacardia- don’t mix! 7 micro grams/ Kg atropine. May need more (10-15 microg/ Kg) if given with opioid- based anesthetic.
0.5-1.5 (usual dose 40-70 mg)
Approx equivalent dose- 35 mg
1-2 min
60 min
Less effective than neo for deep block
Neostigmine
20 mcg/kg atropine (more rapid than neo). 10 microg/ Kg glycopyrrolate (parallels onset of neo). Draw glycol up second (b/c we use it all). But put neo and glycol together and give together to avoid tachycardia.
0.035-0.07 (usual 3-4 mg). Equivalent dose- 3 mg
7-11 min
54 min
Max dose 5 mg. Give for more intense block. Not as good in renal pts. Give for more intense block. Mild hypothermia (34-35 C) decreases clearance, & onset/ peak are delayed
Pyridostigmine 20 micrograms/ Kg atropine (onset receded pyridostigmine). 10 microg/ Kg glycopyrrolate (onset precedes pyrido.)
0.1-0.35 (usual 10-20). Equivalent dose 15 mg
16 min
76 min
Can contribute to post op N/V . Neo is dose related N/V
Reversal decreases incidence of paralysis/ weakness
Neostigmine 3mg with Robinul (glycopyrrolate) .6 mg (5:1)
Neostigmine 3mg with Robinul .4mg (7.5:1)
Muscarinic Antagonists
Give preop for oral and airway secretion reduction, and in peds to prevent bradycardia.
Treatment of reflex-mediated bradycardia
Prevention of motion N?V
Give with anticholinesterase to antagonize NDMR- not mandatory
Placental crossing doesn’t change baby HR
For sedation, give Scopolamine b/c 100 times more potent than atropine for decreasing reticular activating system activity (part of the brain that wakes you up). Enhances benzos and opioids. Volatiles can potentiate anticholinergic drugs on CNS (restlessness and somnolence).
Physostigmine can reverse effects (15-60 micrograms/kg IV).
Central anticholinergic syndrome- usually caused by scopolamine, can be