Anesthetics

Section 8 - MEDICATION GUIDELINES

8.03 ANESTHETICS

Pontocaine Ophthalmic / Local anesthetic

DESCRIPTION

• Ophthalmic anesthetic.

INDICATIONS

• Removal of foreign objects, tonometry.

CONTRAINDICATIONS

• It should not be administered in the presence potential penetrating eye injury. Allergy or sensitivity to PABA.

PRECAUTIONS

• Thorough history must be obtained to rule out penetrating injury.

DOSAGE

• 1-2 gtts - adult and children. Instill in lower conjunctival cornix.

Ketamine / Anesthetic

DESCRIPTION

• Dissociative anesthetic, Systemic. Schedule III controlled substance.

INDICATIONS

• Sedation in the extremely agitated patient

CONTRAINDICATIONS

• Hypersensitivity
• Penetrating eye injury.
• Pregnancy
• Due to sympathomimetic effects, contraindicated in patients with known, severe CAD (for example, patients currently experiencing STEMI).

PRECAUTIONS

• Have ventilatory support readily available
• There is no known antidote or reversal agent for Ketamine
• Emergence Reaction - Read "Special Note" at RxList - Ketamine
  • If this occurs give Benzodiazepine.
    • DIAZEPAM (VALIUM) 2 - 20 mg SLOW IVP or IM to desired effect.
    • MIDAZOLAM (VERSED) 2 - 10 mg IV, IO or IN, titrated to effect.

DOSAGE

• 2 mg/kg SLOW IVP OR 4 mg/kg IM, 1 dose

Onset of action:

• IM administration: 3 – 5 minutes
• IV administration: 1- 2 minutes

Duration of action:

• 20 – 40 minutes when dosed at 4mg/kg IM.
• 12 – 20 minutes when dosed at 2mg/kg IV.

Side Effects:

• Hypertension, emesis, laryngospasm, tachycardia, bronchodilation, increased salivation, emergence reaction (12%).

Etomidate / Anesthetic

DESCRIPTION

• Etomidate is a hypnotic drug without analgesic activity. Intravenous injection of Etomidate produces hypnosis, characterized by a rapid onset of action.

INDICATIONS

• Use during Drug Assisted Intubations.

CONTRAINDICATIONS

• Sepsis, Hypovolemia, Trauma, Hepatic disease, Renal impairment, Labor/ pregnancy.

PRECAUTIONS

• The high likelihood of vomiting (7-30%) necessitates the presence of a working suction unit during intubation attempts.

DOSAGE

• 0.3mg/kg Slow IVP (30 sec. - 1 min). If needed, 2nd dose at 0.3mg/kg not to exceed 0.6mg/kg IVP.
• Refer to Handtevy System for pediatric specific dosages