Medicines used in general anesthesia include the following pre-medications:
Sedation and Anxiolytics
A: Diazepam: IV 0.05–0.1mg/kg OR
C: Diazepam: (PO) 0.5–0.75mg/kg
OR
C: Lorazepam: 0.05mg/kg IM or 0.04mg/kg IV OR
D: Midazolam: 0.05–0.1mg/kg IV
Benzodiazepine antagonists
If there is an overdose with benzodiazepines use the following antidote:
D: Flumazenil: 0.2mg IV one time over 30 seconds. Repeated dose of 0.2mg may be given at 1 minute intervals until desired level of consciousness is achieved; do not exceed 4 doses (1mg).
Antimuscarinics
If there is bradycardia, salivary secretion or other muscarinic side effects give
A: Atropine 0.01mg/kg
OR
S: Glycopyrollate 0.2–0.4mg IV (0.2mg for every 1mg of neostigmine)
Alternatively, a dose of 10–15 µg/kg (0.01–0.015mg/kg) IV with 50 µg/kg (0.05mg/kg) neostigmine or equivalent dose of pyridostigmine
Antiemetic
Indicated for prevention of Post-Operative Nausea and Vomiting (PONV)
A: Dexamethasone sodium phosphate injection 4–5mg IV for PONV prevention
OR
B: Metoclopramide 10mg IV
OR
S: Ondansetron 4 mg IV administered over 2–5minutes
Antacids
Are given to patients at risk of aspiration, such as pregnant women, before Caesarean section
D: Sodium citrate: 0.3Moles, oral, 30mL. Not more than 30 minutes pre– induction of anesthesia
D: Ranitidine Injection 50mg IV as soon as the possibility of surgery is known in cases of emergency procedures
General Anesthetics
Used for induction of anesthesia as boluses or for maintenance of anesthesia as continuous infusions in Total Intra–Venous Anesthesia (TIVA).
B: Ketamine IV, 1–2 mg/kg
OR
C: Thiopental IV, 3–5 mg/kg
OR
D: Propofol IV, 1.5–2.5 mg/kg for induction of anesthesia and 6–12 mg/kg/hour IV infusion for maintenance in TIVA, if volatile agent use for maintenance of anesthesia is contraindicated
OR
S: Etomidate, IV, 0.3 mg/kg (0.2–0.6 mg/kg)
Inhalational anaesthetic agents (for induction and/or maintenance)
B: Halothane 2–4% in air, oxygen or oxygen/nitrous oxide and maintenance
0.5–1.5%
OR
D: Isoflurane 1.2–2.5%, titrate to desired effect
OR
S: Sevoflurane 5–7%
Maintenance: 0.5–3% sevoflurane with or without the concomitant use of nitrous oxide.
Muscle Relaxants
C: Suxamethonium IV, 1–1.5 mg/kg OR
C: Pancuronium I.V 0.04–0.1 mg/kg OR
S: Rocuronium 0.9 mg/kg, IV.
OR
S: Atracurium 0.4–0.5 mg/kg I.V over 60 seconds followed by 0.08–0.1 mg/kg 20–45 minutes after initial dose for maintenance or infusion at 0.05–0.1 mg/kg/min (For patients with renal impairment)
Contraindications: in patients with risk for developing Suxamethonium induced hyperkalaemia, e.g. upper or lower motor neuron defect, prolonged chemical denervation, direct muscle trauma, tumour or inflammation, thermal trauma, disuse atrophy, severe infection.
Medicines for Reversal Of Neuromuscular Blockade
C: Neostigmine IV 50µg/kg with atropine IV, 20µg/kg (maximum 1.2mg) OR
S: Glycopyrrolate IV, 10 µg/kg
OR
S: Sugammadex 2–4mg/kg
Analgesics for Pain Management in Peri–operative Period
Opioid analgesics
B: Tramadol IM/IV, 50mg 6hourly
C: Morphine, IV/IM, 3–5mg as a single dose, then further boluses of 1– 2mg/minute.
Maximum dose of morphine 0.1–0.2 mg/kg, and monitor vitals closely
OR
S: Fentanyl IV, 1–2 µg/kg
OR
C: Pethidine: 1–2mg/kg (used for analgesia during anesthesia, and also during labour)
Antagonists of Opioids
For opioid over–dosage
C: Naloxone: 0.4mg–2mg IV, alternatively may be given intramuscularly or subcutaneously. For reversal of opioid sedation initial dose 0.1–0.2mg IV at 2–3 minutes intervals to the desired degree of reversal.
Non–Opioid Analgesics
B: Paracetamol IV injection 15mg/kg 8hourly
