MAC and TIVA Specifics

Question 1

What is the dosage range for Midazolam (Versed) for MAC?

Answer 1

1-2 mg or 0.025-0.06 mg/kg

NEALSIVMAN

Question 2

What is the onset time for Midazolam?

Answer 2

1-3 mins, peak at 5 mins

Question 3

What is the duration of action for Midazolam?

Answer 3

30-60 minutes
Elimination half-life = 1-4 hours

Question 4

What is the dose of Flumazenil (Romazicon) for MAC?

Answer 4

0.2 mg over 15 seconds, can repeat Q 1 min up to 1 mg total, max dose 3 mg/hr

Question 5

What is the pediatric minimum/maximum dose for Flumazenil?

Answer 5

Peds Min/Max Dose: 0.01 mg/kg and 0.05 mg/kg

Question 6

What is the concentration of Flumazenil?

Answer 6

0.1 mg/ml

Question 7

What are the bolus dosage ranges for Propofol (Diprivan) for MAC?

Answer 7

10-30 mg

Question 8

What is the infusion rate for Propofol (Diprivan) for MAC?

Answer 8

25-75 mcg/kg/min

Question 9

What is the bolus range for Fentanyl (Sublimaze) for MAC?

Answer 9

25-50 mcg

Question 10

What is the onset time for Fentanyl?

Answer 10

1-3 mins, peak in 6 mins

Question 11

What is the duration of action for Fentanyl?

Answer 11

30-60 minutes

Question 12

What is the bolus dosage for Remifentanil (Ultiva) before LA infiltration?

Answer 12

1 mcg/kg over 30-90 seconds (before LA infiltration)

Question 13

What is the infusion rate for Remifentanil (Ultiva) before LA infiltration?

Answer 13

0.05-0.1 mcg/kg/min (5 mins before LA infiltration)

Question 14

What is the onset time for Remifentanil?

Answer 14

60-90 secs

Question 15

What is the context sensitive halftime for Remifentanil?

Answer 15

~3 mins
DOA = 5-10 mins

Question 16

What should the dosage of Remifentanil be if using Versed as well?

Answer 16

Cut in half

Question 17

What is the potential loading dose for Dexmedetomidine (Precedex) for MAC?

Answer 17

0.5-1 mcg/kg over 10 minutes

Question 18

What is the infusion range for Dexmedetomidine (Precedex) for MAC?

Answer 18

0.2-1.2 mcg/kg/HOUR

Question 19

What is the onset time for Dexmedetomidine?

Answer 19

Slower

Question 20

What is the dosage range for Ketamine (Ketalar) for MAC?

Answer 20

0.25-0.5 mg/kg

Question 21

What is the onset time for Ketamine?

Answer 21

1 minute

Question 22

What is the duration of action for Ketamine?

Answer 22

10-20 mins

Question 23

What is the elimination time for Ketamine?

Answer 23

2-3 hours

Question 24

What is the recommended medication combination for procedures with brief initial pain? (Blocks, LA Infiltration, Femoral Access)

Answer 24

Midazolam 1-2 mg, fentanyl 50-100 mcg, and/or propofol 0.5-1 mg/kg over 1-2 minutes

Question 25

What is the recommended medication combination for procedures with variable pain/discomfort? (GI Endoscopy, etc.)

Answer 25

Propofol bolus 0.5-1 mg/kg then propofol infusion 25-100 mcg/kg/min, PRN fentanyl 25-50 mcg or ketamine 0.5-1 mg/kg

Question 26

What should be considered for patients with morbid obesity/sleep apnea during variable pain procedures?

Answer 26

Dexmedetomidine infusion

Question 27

What is the infusion rate for Propofol for TIVA?

Answer 27

75-150 mcg/kg/min

Question 28

What should be done to the Propofol dose for older age, hypovolemia, or myocardial dysfunction?

Answer 28

Decrease dose (May need more in young healthy patients or those with cross tolerance)

Question 29

What is the induction dose for Remifentanil for TIVA?

Answer 29

0.5-1 mcg/kg

Question 30

What is the maintenance dose for Remifentanil for TIVA?

Answer 30

0.1-0.25 mcg/kg/min

Question 31

What is the dosage range for Sufentanil (Sudentanil) for TIVA?

Answer 31

0.2-1 mcg/kg/hr Used for longer TIVA procedures or significant pain potential

Question 32

What should be done for significant post-pain expected with Hydromorphone/Morphine for TIVA?

Answer 32

Administer 20-30 mins or longer before emergence

Question 33

What is the loading dose for Dexmedetomidine for TIVA?

Answer 33

0.5-1 mcg/kg over 10 minutes SAME AS FOR MAC, DECREASE PROPOFOL IF USING

Question 34

What is the infusion range for Dexmedetomidine for TIVA?

Answer 34

0.2-1.2 mcg/kg/HOUR SAME AS FOR MAC, DECREASE PROPOFOL IF USING

Question 35

What is the dosage range for Ketamine for TIVA?

Answer 35

0.25-0.5 mg/kg SAME AS FOR MAC, DECREASE PROPOFOL IF USING

Question 36

What is the maximum dose for Lidocaine if used on induction without Epi?

Answer 36

4.5 mg/kg

Question 37

What is the maximum dose for Lidocaine if used on induction with Epi?

Answer 37

7 mg/kg

Question 38

What is the infusion rate for Lidocaine for TIVA?

Answer 38

1-2 mg/kg/hr if lean body weight