Template:Sedative agents - Revision history

Danbot: Convert to MedicationDose template — single source of truth with SMW; verify all dosing; fix etomidate procedural sedation content

2026-03-20T15:48:38Z

Convert to MedicationDose template — single source of truth with SMW; verify all dosing; fix etomidate procedural sedation content

← Older revision		Revision as of 15:48, 20 March 2026
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	*[[Propofol]] is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension		*[[Propofol]] is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension
	*[[Etomidate]] used less frequently than other agents; causes myoclonus that is undesirable for orthopedic reduction		*[[Etomidate]] used less frequently than other agents; causes myoclonus that is undesirable for orthopedic reduction

	===[[Ketamine]]===		===[[Ketamine]]===
	*Noncompetitive NMDA receptor antagonist that produced dissociative state		*Noncompetitive NMDA receptor antagonist that produced dissociative state
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	*Safe to use in children undergoing procedural sedation and analgesia (Level A recommendation)<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>		*Safe to use in children undergoing procedural sedation and analgesia (Level A recommendation)<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>
	*Maintains upper airway tone, protective reflexes, and spontaneous breathing		*Maintains upper airway tone, protective reflexes, and spontaneous breathing
	*Little evidence to advocate for prevention of emergence phenomenon, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)<ref>Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2</ref>		*Little evidence to advocate for prevention of emergence phenomenon, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)<ref>Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2</ref>
	**Versed can be used subsequently if emergence reaction occurs		**Versed can be used subsequently if emergence reaction occurs
			*{{MedicationDose\|drug=Ketamine\|dose=1-2 mg/kg\|route=IV\|context=Procedural sedation\|indication=Procedural sedation\|population=Adult\|duration=10-20 min\|notes=Followed by 0.5-1 mg/kg IV PRN}}
	*1-2 mg/kg IV~~, followed~~ by 0.5-1 mg/kg IV PRN		*{{MedicationDose\|drug=Ketamine\|dose=4-5 mg/kg\|route=IM\|context=Procedural sedation (IM)\|indication=Procedural sedation\|population=Adult\|duration=10-20 min\|notes=Repeat 2-4 mg/kg IM after 10 min if unsuccessful}}
	*4-5 mg/kg IM ~~→ repeat~~ 2-4 mg/kg IM after 10 min if ~~first~~ dose ~~unsuccessful~~		*{{MedicationDose\|drug=Ketamine\|dose=1.5-2 mg/kg\|route=IV\|context=Procedural sedation\|indication=Procedural sedation\|population=Pediatric\|notes=Safe for children (Level A)}}
	*~~Duration 10 to 20 minutes~~		*{{MedicationDose\|drug=Ketamine\|dose=4-5 mg/kg\|route=IM\|context=Procedural sedation (IM)\|indication=Procedural sedation\|population=Pediatric}}
			*{{MedicationDose\|drug=Ketamine\|dose=3-6 mg/kg\|route=IN\|context=Procedural sedation (IN)\|indication=Procedural sedation\|population=Pediatric}}<ref>Hall, D, et al. Intranasal ketamine for procedural sedation. Emerg Med J. 2014; 31:789-90.</ref>

	===[[Propofol]]===		===[[Propofol]]===
	*Potentiates GABA receptors, sedative hypnotic agent without analgesic properties		*Potentiates GABA receptors, sedative hypnotic agent without analgesic properties
	*Rapid onset <1 min, short duration <10 min, predictable dose dependent potency		*Rapid onset <1 min, short duration <10 min, predictable dose dependent potency
	*0.5-~~1mg~~/kg IV over 3-5 ~~mins, repeat~~ 0.5 mg/kg q3-5 min PRN		*{{MedicationDose\|drug=Propofol\|dose=0.5-1 mg/kg IV over 3-5 min\|route=IV\|context=Procedural sedation\|indication=Procedural sedation\|population=Adult\|onset=<1 min\|duration=<10 min\|notes=Repeat 0.5 mg/kg q3-5 min PRN}}
	*Can cause dose-related respiratory depression, hypotension, and decreased cardiac output, however, rarely leads to unplanned intubation, prolonged observation, or complications requiring admission <ref> Blackburn 2000, Burnton JH, Miner JR, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13(1):24-30 </ref>		*Can cause dose-related respiratory depression, hypotension, and decreased cardiac output, however, rarely leads to unplanned intubation, prolonged observation, or complications requiring admission <ref> Blackburn 2000, Burnton JH, Miner JR, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13(1):24-30 </ref>
	*Can cause sympathomimetic effects, such as tachycardia, hypertension, and increased cardiac output, and caution should be used in patients with known or suspected coronary artery disease

	===[[Fentanyl]]/[[Midazolam]]===		===[[Fentanyl]]/[[Midazolam]]===
	*~~Dose fentanyl first:~~ 0.5-~~1mcg~~/kg		*{{MedicationDose\|drug=Fentanyl\|dose=0.5-1 mcg/kg\|route=IV\|context=Procedural sedation (with midazolam)\|indication=Procedural sedation\|population=Adult\|notes=Dose fentanyl first}}
	*~~Follow with~~ 1-2 mg ~~of [[midazolam]]~~		*{{MedicationDose\|drug=Midazolam\|dose=1-2 mg\|route=IV\|context=Procedural sedation (with fentanyl)\|indication=Procedural sedation\|population=Adult\|duration=30 min\|notes=Follow fentanyl; designed for moderate sedation}}
	*Designed for moderate sedation		*Combination of other [[opioids]] with [[benzodiazepines]] such as [[lorazepam]] is possible
	**Too deep when painful stimulus stops the patient may become apneic
	**Combination of other [[opioids]] with [[benzodiazepines]] such as [[lorazepam]] is possible
	*Duration 30min

	===[[Fentanyl]]/[[Etomidate]]===		===[[Fentanyl]]/[[Etomidate]]===
	*Similar to ~~fentnayl~~/midazolam, but better because shorter duration of action		*Similar to fentanyl/midazolam, but better because shorter duration of action
	*An alternative to propofol for brief sedation		*An alternative to propofol for brief sedation (e.g. shoulder/hip reduction, cardioversion)
	**E.g. shoulder/hip reduction, cardioversion		*Can cause myoclonus<ref> Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med. 2003;21:556-558.</ref>
	*Can cause myoclonus<ref> Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med. 2003;21:556-558.</ref> ~~and occaisonly adrenal supression.~~		*{{MedicationDose\|drug=Fentanyl\|dose=0.5-1 mcg/kg\|route=IV\|context=Procedural sedation (with etomidate)\|indication=Procedural sedation\|population=Adult\|notes=Dose fentanyl first}}
	*~~Dose fentanyl first:~~ 0.5-~~1mcg~~/kg		*{{MedicationDose\|drug=Etomidate\|dose=0.15 mg/kg\|route=IV\|context=Procedural sedation\|indication=Procedural sedation\|population=Adult\|duration=6 min\|notes=Average 8-10 mg}}
	*Etomidate 0.~~15mg~~/kg (8-~~10mg avg)~~
	*Duration: 6min

	===Brevital (Methohexital)/[[Fentanyl]]===		===Brevital (Methohexital)/[[Fentanyl]]===
	*Suppresses the reticular activating center in the brainstem and cerebral cortex, thereby causing sedation		*Suppresses the reticular activating center in the brainstem and cerebral cortex, thereby causing sedation
	*Sedation and amnesia, no analgesia		*Sedation and amnesia, no analgesia
	*~~Dose fentanyl first:~~ 0.5-~~1mcg~~/kg		*{{MedicationDose\|drug=Fentanyl\|dose=0.5-1 mcg/kg\|route=IV\|context=Procedural sedation (with brevital)\|indication=Procedural sedation\|population=Adult\|notes=Dose fentanyl first}}
	*~~Initial~~ dose 0.75 ~~to 1mg~~/kg IV		*{{MedicationDose\|drug=Methohexital\|dose=0.75-1 mg/kg\|route=IV\|context=Procedural sedation\|indication=Procedural sedation\|population=Adult\|onset=immediate\|duration=<10 min\|display=Brevital\|notes=Repeat 0.5 mg/kg IV q2 min PRN}}
	*Repeat ~~doses of~~ 0.~~5mg~~/kg IV ~~can be given every two minutes.~~
	*Immediate onset, duration <10 minutes

	===[[Propofol]]/[[Ketamine]] ([[Ketofol]])===		===[[Propofol]]/[[Ketamine]] ([[Ketofol]])===
	*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>		*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>
	*Safe in children and adults undergoing procedural sedation and anesthesia (Level B ~~Reccomendation~~)<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>		*Safe in children and adults undergoing procedural sedation and anesthesia (Level B Recommendation)<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>
	*Theorized that side-effect profiles counter one another		*Theorized that side-effect profiles counter one another
	**Propofol-associated hypotension and respiratory depression can theoretically be reduced with increases in circulatory norepinephrine induced by ketamine		**Propofol-associated hypotension and respiratory depression can theoretically be reduced with increases in circulatory norepinephrine induced by ketamine
	**Ketamine associated nausea and emergence reactions are theoretically reduced by the antiemetic and anxiolytic properties of propofol		**Ketamine associated nausea and emergence reactions are theoretically reduced by the antiemetic and anxiolytic properties of propofol
	*A study of pediatric patients found the total patient sedation times to be shorter (3 minutes) with the combined ketamine and propofol regimen compared with ketamine alone<ref>Shah A, Mosdossy G, McLeod S, et al. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011;57:425-433.</ref>		*A study of pediatric patients found the total patient sedation times to be shorter (3 minutes) with the combined ketamine and propofol regimen compared with ketamine alone<ref>Shah A, Mosdossy G, McLeod S, et al. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011;57:425-433.</ref>
	*~~Dose:~~ 0.~~5mg~~/kg propofol ~~with~~ 0.~~5mg~~/kg ketamine ~~(may~~ be mixed in same syringe or given separately)		*{{MedicationDose\|drug=Ketofol\|dose=0.5 mg/kg propofol + 0.5 mg/kg ketamine\|route=IV\|context=Procedural sedation\|indication=Procedural sedation\|population=Adult\|notes=May be mixed in same syringe or given separately}}

	===[[Dexmedetomidine]]===		===[[Dexmedetomidine]]===
	*1 mcg/kg loading ~~dose followed by~~ 0.2-1 mcg/kg/hr ~~maintenance dose~~		*{{MedicationDose\|drug=Dexmedetomidine\|dose=1 mcg/kg loading then 0.2-1 mcg/kg/hr\|route=IV\|context=Procedural sedation\|indication=Procedural sedation\|population=Adult\|notes=Avoid in heart blocks; may supplement with midazolam 1-2 mg}}
	*Side effects include bradycardia and hypotension.		*Side effects include bradycardia and hypotension
	*Avoid in ~~patients with~~ heart blocks
	*May need to supplement with 1-2 mg ~~of [[midazolam]]~~

	===[[Etomidate]]===		===[[Etomidate]]===
	{{~~Procedure~~ sedation ~~etomidate~~}}		*{{MedicationDose\|drug=Etomidate\|dose=0.1-0.2 mg/kg\|route=IV\|context=Procedural sedation (solo)\|indication=Procedural sedation\|population=Adult\|notes=One-time dosing; max 10 mg}}

Rossdonaldson1: /* Sedative agents */

2024-04-17T17:43:20Z

Sedative agents

@@ Line 4: / Line 4: @@
 *[[Propofol]] is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension
 *[[Etomidate]] used less frequently than other agents; causes myoclonus that is undesirable for orthopedic reduction
 ===[[Fentanyl]]/[[Midazolam]]===
 *Dose fentanyl first: 0.5-1mcg/kg
@@ Line 28: / Line 47: @@
 *Repeat doses of 0.5mg/kg IV can be given every two minutes.
 *Immediate onset, duration <10 minutes
 ===[[Propofol]]/[[Ketamine]] ([[Ketofol]])===

ClaireLewis: /* Propofol */

2019-08-20T00:39:01Z

Propofol

← Older revision		Revision as of 00:39, 20 August 2019
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	===[[Propofol]]===		===[[Propofol]]===
	*Potentiates GABA receptors, sedative hypnotic agent without analgesic properties		*Potentiates GABA receptors, sedative hypnotic agent without analgesic properties
	*Rapid onset ~~less than one minute~~, short duration ~~less than~~ 10 ~~minutes and~~ predictable dose dependent potency		*Rapid onset <1 min, short duration <10 min, predictable dose dependent potency
	*~~Initial IV bolus~~ 0.5-1mg/kg over 3-5 ~~mints~~, repeat ~~IV of~~ 0.5 mg/kg ~~every 3~~-5 ~~minutes as needed~~		*0.5-1mg/kg IV over 3-5 mins, repeat 0.5 mg/kg q3-5 min PRN
	*Can cause dose-related respiratory depression, hypotension, and decreased cardiac output, however, rarely leads to unplanned intubation, prolonged observation, or complications requiring admission <ref> Blackburn 2000, Burnton JH, Miner JR, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13(1):24-30 </ref>		*Can cause dose-related respiratory depression, hypotension, and decreased cardiac output, however, rarely leads to unplanned intubation, prolonged observation, or complications requiring admission <ref> Blackburn 2000, Burnton JH, Miner JR, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13(1):24-30 </ref>
	*Can cause sympathomimetic effects, such as tachycardia, hypertension, and increased cardiac output, and caution should be used in patients with known or suspected coronary artery disease		*Can cause sympathomimetic effects, such as tachycardia, hypertension, and increased cardiac output, and caution should be used in patients with known or suspected coronary artery disease

Gregtong: /* Ketamine */

2019-08-19T21:09:12Z

Ketamine

← Older revision		Revision as of 21:09, 19 August 2019
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	*Duration 10 to 20 minutes		*Duration 10 to 20 minutes

	===[[Propofol}}===		===[[Propofol]]===
	*Potentiates GABA receptors, sedative hypnotic agent without analgesic properties		*Potentiates GABA receptors, sedative hypnotic agent without analgesic properties
	*Rapid onset less than one minute, short duration less than 10 minutes and predictable dose dependent potency		*Rapid onset less than one minute, short duration less than 10 minutes and predictable dose dependent potency
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	*Can cause dose-related respiratory depression, hypotension, and decreased cardiac output, however, rarely leads to unplanned intubation, prolonged observation, or complications requiring admission <ref> Blackburn 2000, Burnton JH, Miner JR, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13(1):24-30 </ref>		*Can cause dose-related respiratory depression, hypotension, and decreased cardiac output, however, rarely leads to unplanned intubation, prolonged observation, or complications requiring admission <ref> Blackburn 2000, Burnton JH, Miner JR, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13(1):24-30 </ref>
	*Can cause sympathomimetic effects, such as tachycardia, hypertension, and increased cardiac output, and caution should be used in patients with known or suspected coronary artery disease		*Can cause sympathomimetic effects, such as tachycardia, hypertension, and increased cardiac output, and caution should be used in patients with known or suspected coronary artery disease

	===[[Propofol]]/[[Ketamine]] ([[Ketofol]])===		===[[Propofol]]/[[Ketamine]] ([[Ketofol]])===
	*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>		*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>

Gregtong: /* Sedative agents */

2019-08-19T21:08:50Z

Sedative agents

← Older revision		Revision as of 21:08, 19 August 2019
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	*Little evidence to advocate for prevention of emergence phenomenon, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)<ref>Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2</ref>		*Little evidence to advocate for prevention of emergence phenomenon, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)<ref>Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2</ref>
	**Versed can be used subsequently if emergence reaction occurs		**Versed can be used subsequently if emergence reaction occurs

	*1-2 mg/kg IV, followed by 0.5-1 mg/kg IV PRN		*1-2 mg/kg IV, followed by 0.5-1 mg/kg IV PRN
	*4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful		*4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful
	*Duration 10 to 20 minutes		*Duration 10 to 20 minutes

			===[[Propofol}}===
			*Potentiates GABA receptors, sedative hypnotic agent without analgesic properties
			*Rapid onset less than one minute, short duration less than 10 minutes and predictable dose dependent potency
			*Initial IV bolus 0.5-1mg/kg over 3-5 mints, repeat IV of 0.5 mg/kg every 3-5 minutes as needed
			*Can cause dose-related respiratory depression, hypotension, and decreased cardiac output, however, rarely leads to unplanned intubation, prolonged observation, or complications requiring admission <ref> Blackburn 2000, Burnton JH, Miner JR, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13(1):24-30 </ref>
			*Can cause sympathomimetic effects, such as tachycardia, hypertension, and increased cardiac output, and caution should be used in patients with known or suspected coronary artery disease
	===[[Propofol]]/[[Ketamine]] ([[Ketofol]])===		===[[Propofol]]/[[Ketamine]] ([[Ketofol]])===
	*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>		*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>

Spenceemmett: /* Sedative agents */

2019-05-05T02:55:29Z

Sedative agents

Ostermayer: /* Sedative agents */

2018-11-28T19:39:23Z

Sedative agents

← Older revision		Revision as of 19:39, 28 November 2018
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	*[[Ketamine]] offers the greatest safety profile overall but caution in the elderly or patients with known cardiovascular disease due to sympathetic surge		*[[Ketamine]] offers the greatest safety profile overall but caution in the elderly or patients with known cardiovascular disease due to sympathetic surge
	*[[Propofol]] is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension		*[[Propofol]] is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension
			*[[Etomidate]] used less frequently than all other agents but does cause myoclonus that is undesirable for an orthopedic reduction
	===[[Fentanyl]]/[[Midazolam]]===		===[[Fentanyl]]/[[Midazolam]]===
	*Dose fentanyl first: 0.5-1mcg/kg		*Dose fentanyl first: 0.5-1mcg/kg
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	*Avoid in patients with heart blocks		*Avoid in patients with heart blocks
	*May need to supplement with 1-2 mg of [[midazolam]]		*May need to supplement with 1-2 mg of [[midazolam]]

			===[[Etomidate]]===
			{{Procedure sedation etomidate}}

Mholtz at 22:14, 31 December 2016

2016-12-31T22:14:43Z

← Older revision		Revision as of 22:14, 31 December 2016
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	*Duration 30min		*Duration 30min

	===[[~~Etomidate~~]]/[[~~Fentanyl~~]]===		===[[Fentanyl]]/[[Etomidate]]===
	*Similar to versed/fentanyl but better because of shorter duration of action		*Similar to versed/fentanyl but better because of shorter duration of action
	*An alternative to propofol for brief sedation		*An alternative to propofol for brief sedation

Mholtz: /* Sedative agents */

2016-12-31T22:14:04Z

Sedative agents

← Older revision		Revision as of 22:14, 31 December 2016
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	==[[Sedative agents]]==		==[[Sedative agents]]==
	*The ideal ~~combination~~ is a short-acting ~~agent~~ with minimal respiratory or hemodynamic depression		*The ideal agent is short-acting with minimal respiratory or hemodynamic depression
	*[[Ketamine]] offers the greatest safety profile overall but caution in the elderly or patients with known cardiovascular disease due to sympathetic surge		*[[Ketamine]] offers the greatest safety profile overall but caution in the elderly or patients with known cardiovascular disease due to sympathetic surge
	*[[Propofol]] is used ~~often~~ due to ~~profound~~ relaxation ~~that occurs for orthopedic related procedures~~ but can cause respiratory depression and hypotension		*[[Propofol]] is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension

	===[[Fentanyl]]/[[Midazolam]]===		===[[Fentanyl]]/[[Midazolam]]===
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	*Dose fentanyl first: 0.5-1mcg/kg		*Dose fentanyl first: 0.5-1mcg/kg
	*Etomidate 0.15mg/kg (8-10mg avg)		*Etomidate 0.15mg/kg (8-10mg avg)
	**Duration 6min		*Duration: 6min

	===Brevital (Methohexital)/[[Fentanyl]]===		===Brevital (Methohexital)/[[Fentanyl]]===
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	*Duration 10 to 20 minutes		*Duration 10 to 20 minutes

	===[[Propofol]]/[[Ketamine]] (Ketofol)===		===[[Propofol]]/[[Ketamine]] ([[Ketofol]])===
	*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>		*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>
	*Safe in children and adults undergoing procedural sedation and anesthesia (Level B Reccomendation)<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>		*Safe in children and adults undergoing procedural sedation and anesthesia (Level B Reccomendation)<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>
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	**Ketamine associated nausea and emergence reactions are theoretically reduced by the antiemetic and anxiolytic properties of propofol		**Ketamine associated nausea and emergence reactions are theoretically reduced by the antiemetic and anxiolytic properties of propofol
	*A study of pediatric patients found the total patient sedation times to be shorter (3 minutes) with the combined ketamine and propofol regimen compared with ketamine alone<ref>Shah A, Mosdossy G, McLeod S, et al. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011;57:425-433.</ref>		*A study of pediatric patients found the total patient sedation times to be shorter (3 minutes) with the combined ketamine and propofol regimen compared with ketamine alone<ref>Shah A, Mosdossy G, McLeod S, et al. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011;57:425-433.</ref>
	*Dose: 0.5mg/kg propofol with 0.5mg/kg ketamine (may be mixed in same syringe)		*Dose: 0.5mg/kg propofol with 0.5mg/kg ketamine (may be mixed in same syringe or given separately)

	===[[Dexmedetomidine]]===		===[[Dexmedetomidine]]===

Neil.m.young at 02:08, 16 August 2016

2016-08-16T02:08:18Z

← Older revision		Revision as of 02:55, 5 May 2019
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	*[[Ketamine]] offers the greatest safety profile overall but caution in the elderly or patients with known cardiovascular disease due to sympathetic surge		*[[Ketamine]] offers the greatest safety profile overall but caution in the elderly or patients with known cardiovascular disease due to sympathetic surge
	*[[Propofol]] is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension		*[[Propofol]] is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension
	*[[Etomidate]] used less frequently than ~~all~~ other agents ~~but does cause~~ myoclonus that is undesirable for an orthopedic reduction		*[[Etomidate]] used less frequently than other agents; causes myoclonus that is undesirable for orthopedic reduction
	===[[Fentanyl]]/[[Midazolam]]===		===[[Fentanyl]]/[[Midazolam]]===
	*Dose fentanyl first: 0.5-1mcg/kg		*Dose fentanyl first: 0.5-1mcg/kg
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	*Designed for moderate sedation		*Designed for moderate sedation
	**Too deep when painful stimulus stops the patient may become apneic		**Too deep when painful stimulus stops the patient may become apneic
	**Combination of other [[opioids]] with [[benzodiazepines]] such as [[~~Lorazepam~~]] is possible		**Combination of other [[opioids]] with [[benzodiazepines]] such as [[lorazepam]] is possible
	*Duration 30min		*Duration 30min

	===[[Fentanyl]]/[[Etomidate]]===		===[[Fentanyl]]/[[Etomidate]]===
	*Similar to ~~versed~~/~~fentanyl~~ but better because of shorter duration of action		*Similar to fentnayl/midazolam, but better because shorter duration of action
	*An alternative to propofol for brief sedation		*An alternative to propofol for brief sedation
	**E.g. shoulder/hip reduction, cardioversion		**E.g. shoulder/hip reduction, cardioversion

← Older revision		Revision as of 02:08, 16 August 2016
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	==[[Sedative agents]]==		==[[Sedative agents]]==
	The ideal combination is a short acting agent with minimal respiratory or hemodynamic depression. Ketamine offers the greatest safety profile ~~over all~~ but ~~should be used with~~ caution in the ~~ederly~~ or patients with known cardiovascular disease due to ~~the~~ sympathetic surge. Propofol is used often due to ~~the~~ profound relaxation that occurs for orthopedic related procedures but can cause respiratory depression and hypotension		*The ideal combination is a short-acting agent with minimal respiratory or hemodynamic depression
			*[[Ketamine]] offers the greatest safety profile overall but caution in the elderly or patients with known cardiovascular disease due to sympathetic surge
			*[[Propofol]] is used often due to profound relaxation that occurs for orthopedic related procedures but can cause respiratory depression and hypotension

	===[[Fentanyl]]/[[Midazolam]]===		===[[Fentanyl]]/[[Midazolam]]===
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	*Follow with 1-2 mg of [[midazolam]]		*Follow with 1-2 mg of [[midazolam]]
	*Designed for moderate sedation		*Designed for moderate sedation
	**~~If titrate to~~ deep ~~sedation,~~ when painful stimulus stops the patient may become apneic		**Too deep when painful stimulus stops the patient may become apneic
	**Combination of other [[~~Opioids~~]] with [[~~Benzodiazepines~~]] is possible		**Combination of other [[opioids]] with [[benzodiazepines]] such as [[Lorazepam]] is possible
	*Duration = 30min		*Duration 30min
	*Can substitute midazolam for [[Lorazepam]] if the former is not available.

	===[[Etomidate]]/[[Fentanyl]]===		===[[Etomidate]]/[[Fentanyl]]===
	*Similar to versed/fentanyl but better ~~b/c~~ of shorter duration of action		*Similar to versed/fentanyl but better because of shorter duration of action
	*~~Good~~ for brief sedation ~~if don't have access to propofol~~		*An alternative to propofol for brief sedation
	**E.g. shoulder/hip reduction, cardioversion		**E.g. shoulder/hip reduction, cardioversion
	*~~Disadvante of~~ myoclonus<ref> Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med. 2003;21:556-558.</ref> and occaisonly adrenal supression.		*Can cause myoclonus<ref> Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med. 2003;21:556-558.</ref> and occaisonly adrenal supression.
	*Dose fentanyl first: 0.5-1mcg/kg		*Dose fentanyl first: 0.5-1mcg/kg
	*Etomidate 0.15mg/kg (8-10mg avg)		*Etomidate 0.15mg/kg (8-10mg avg)
	**~~Wears off in~~ 6min		**Duration 6min

	===Brevital (Methohexital)/[[Fentanyl]]===		===Brevital (Methohexital)/[[Fentanyl]]===
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	*Noncompetitive NMDA receptor antagonist that produced dissociative state		*Noncompetitive NMDA receptor antagonist that produced dissociative state
	*Sedation, analgesia, and amnesia		*Sedation, analgesia, and amnesia
	*~~Level A reccomendation: Ketamine safe~~ to use in children undergoing procedural sedation and analgesia<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>		*Safe to use in children undergoing procedural sedation and analgesia (Level A recommendation)<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>
	*~~Maintain~~ upper airway tone, protective reflexes, spontaneous breathing		*Maintains upper airway tone, protective reflexes, and spontaneous breathing
	*Little evidence to advocate for prevention of emergence phenomenon, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)<ref>Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2</ref>		*Little evidence to advocate for prevention of emergence phenomenon, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)<ref>Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2</ref>
	**Versed can be used subsequently if emergence reaction occurs ~~once sedation is complete~~		**Versed can be used subsequently if emergence reaction occurs
	*1-2 mg/kg IV, followed by 0.5-1 mg/kg IV PRN		*1-2 mg/kg IV, followed by 0.5-1 mg/kg IV PRN
	*4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful		*4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful
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	===[[Propofol]]/[[Ketamine]] (Ketofol)===		===[[Propofol]]/[[Ketamine]] (Ketofol)===
	*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>		*1:1 mixture of ketamine and propofol<ref>Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012; 59(6): 504-12.e1-2. PMID: 22401952</ref>
	*~~Level B Reccomendation: ketamine and propofol is safe~~ in children and adults undergoing procedural sedation and anesthesia<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>		*Safe in children and adults undergoing procedural sedation and anesthesia (Level B Reccomendation)<ref name="ACEP">ACEP Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department [http://www.acep.org/workarea/DownloadAsset.aspx?id=93816 full text]</ref>
	*Theorized that side-effect profiles counter one another		*Theorized that side-effect profiles counter one another
	**Propofol associated hypotension and respiratory depression can theoretically be reduced with increases in circulatory norepinephrine induced by ketamine.		**Propofol-associated hypotension and respiratory depression can theoretically be reduced with increases in circulatory norepinephrine induced by ketamine
	**Ketamine associated nausea and emergence reactions are theoretically reduced by the antiemetic and anxiolytic properties of propofol.		**Ketamine associated nausea and emergence reactions are theoretically reduced by the antiemetic and anxiolytic properties of propofol
	*A study of pediatric patients found the total patient sedation times to be shorter (3 minutes) with the combined ketamine and propofol regimen compared with ketamine alone<ref>Shah A, Mosdossy G, McLeod S, et al. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011;57:425-433.</ref>		*A study of pediatric patients found the total patient sedation times to be shorter (3 minutes) with the combined ketamine and propofol regimen compared with ketamine alone<ref>Shah A, Mosdossy G, McLeod S, et al. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011;57:425-433.</ref>
	*Dose: 0.5mg/kg propofol with 0.5mg/kg ketamine (may be mixed in same syringe)		*Dose: 0.5mg/kg propofol with 0.5mg/kg ketamine (may be mixed in same syringe)