(Only dopaminergic receptors stimulated at less than 2 mcg/kg/min, Beta at 2-5 mcg/kg/min, Alpha at rates greater than 10 mcg/kg/min)
5-200 mcg/min IV infusion (200= max dose)
0.4 mg SL q5 x 3 doses
Bolus 10-15 mg
Infusion: 25-350 mcg/kg/min
(loading dose of 500mcg/kg/min for 1 min then titrate)
0.03-0.15 mcg/kg/min (alpha and beta)
0.15-0.3 mcg/kg/min (alpha
2.5mg neb q4-6 hours
2 mg PO
(1-2.5 mg/kg)150-300 PO
20-40mg IV (up to 200mg/dose for acute pulmonary edema)
20-80mg PO (qday or q6-8 hrs for edema, HTN; not to exceed 600mg/day)
6-8 hours PO
30 min IM
30-60 min PO/SL
1-2 hours PO/SL
repeat PRN q 1.5-3.5 hours
0.2 mg IM q2-4 (not to exceed 5 doses)
(Then 0.2-0.4 mg PO q6-8 hours for 2-7 days)
0.05-2 mcg/kg/min (infusion)
IM 15 minutes
PO 30 minutes
IM up to 6 hours
IV 0.02-0.03 mg/kg
Induction 0.1-0.2 mg/kg
(NMB Reversal 10 mcg/kg with edrophonium
0.02 mg/kg peds)
(w/ robinul 0.2mg for every 1 mg of neostig)
0.2 mg for every 1mg of neostig or 10 mcg/kg
RSI: 1-1.5 mg/kg
hypotension, irritation on injection
selective alpha-1 agonist causing vasoconstriction of arterioles and venuoles
Beta & Alpha agonist mix direct & indirect
Alpha & Beta agonist, increased HR, bronchodilator
Selective Beta-1 antagonist
Selective Beta-1 antagonist
Alpha & Beta antagonist (1:7 – Alpha/Beta)
activation of K channels causing hyperpolarization of smooth cells preventing vasoconstriction (requires Nitric Oxide for vasodilation)
A 23 yo F presents to your office for an evaluation of her third molars. Teeth #1 and #16 are erupted/malposed, and #17 and #32 are slightly mesioangular PBIs. On history you discover that she has asthma and smokes cigarettes, 1 PPD for the past 10 years. Her medications include Advair Inhaler BID, Proventil prn, and orthotrycycline BCP (although she occasionally misses a dose and she has not had her period for a couple months). On further questioning, you also find out that she takes a MVI, additional vit E, and an herbal “mood pack” containing St John’s Wort, ecchinacea, ginko biloba, and garlic. She wants to be “asleep” during her surgery.
What questions would you ask this patient, pertaining to the findings in the medical history?
Aside from CC, HPI, PMedHx, PSurHx, FamHx, ALL, ROS…
How frequent and severe are the asthma attacks, what precipitates them, has she ever been to the ER or hospitalized for them. Is she sexually active, and is there a possibility she could be pregnant?
IV – soft palate not visible) & physical factors like mandibular position/size and ability to extend neck. I look at pupils for size and reactivity, and assess CN V & VII function as pertinent to any potential surgical procedures. I auscultate the heart and lungs.
On auscultation, her lungs are clear and you hear a soft, but unmistakeably present systolic ejection murmur at the left sternal border. She has never been told that she has a murmur.
How would you grade the heart murmur?
1. The murmur is only audible on listening carefully for some time.
2. The murmur is *faint* but immediately audible on placing the stethoscope on the chest.
3. A loud murmur readily audible but with no palpable thrill.
4. A loud murmur with a palpable thrill.
5. A loud murmur with a palpable thrill. The murmur is so loud that it is audible with only the rim of the stethoscope touching the chest.
6. A loud murmur with a palpable thrill. The murmur is audible with the stethoscope not touching the chest but lifted just off it.
Pulmonic region – the 2nd left intercostal spaces.
Tricuspid region – the 5th left intercostal space (STERNAL)
Mitral region – the 5th left mid-clavicular intercostal space. (near nipple)
On referral to her physician, a pregnancy test is ordered and comes back positive. She is near the end of her first trimester.
What is the likely etiology of the murmur?
The patient recovers from the p-cor and goes on to an uncomplicated delivery. She presents 6 months later for removal of her remaining third molars. She no longer has a murmur on auscultation. She wants to be “completely asleep” for the surgery this time.
What additional questions will you ask her?
ASA 1-Normal healthy patient
ASA 2-Controlled systemic disease without functional limitation
ASA 3-Severe systemic disease with functional limitation
ASA 4-Severe systemic disease that is a constant threat to life
ASA 5-Moribund patient, not expected to survive without operation
ASA 6-Brain-dead, organ donor
(E)-Designator for any patient requiring an emergency operation
The patient desires a general anesthetic and you decide to treat her in the Outpatient Surgery Center of your local hospital. The anesthetist induces anesthesia with Propofol, and is using Sevofluorane for maintenance.
What are Propofol and Sevofluorane?