Page 258 - Critical Care Notes

4223_Tab10_249-258 29/08/14 10:03 AM Page 252

CC MEDS
2 mcg/kg/min for 18 hr and a second 180 mcg/kg bolus, 10 min after first
bolus; continue infusion for up to 18–24 hr.
esmolol, Brevibloc: Beta-adrenergic blocker (antidysrhythmic II). Uses: SVT, non-
compensatory sinus tachycardia, hypertensive crisis, intraoperative and post-
operative tachycardia and HTN. Dosages: IV loading dose 500 mcg/kg/min
over 1 min; maintenance 50 mcg/kg/min for 4 min; if no response in 5 min,
give second loading dose; then increase infusion to 100 mcg/kg/min for
4 min; if no response, repeat loading dose, then increase maintenance infu-
sion by 50 mcg/kg/min (max 200 mcg/kg/min), titrate to patient response.
etomidate, Amidate: General anesthetic. Use: Induction of general anesthesia.
Dosages: IV 0.2–0.6 mg/kg over ⁄2–1 min.
1
fenoldopam, Corlopam: Antihypertensive, vasodilator. Uses: Hypertensive
crisis, malignant HTN. Dosages: IV 0.01–1.6 mcg/kg/min.
fentanyl, Fentanyl: Opioid analgesic. Uses: Preoperatively, postoperatively;
adjunct to general anesthetic, adjunct to regional anesthesia; Fentanyl
Oralet: Anesthesia as premedication, conscious sedation. Dosages:
Anesthetic: IV 25–100 mcg (0.7–2 mcg/kg) every 2–3 min prn. Anesthesia
supplement: IV 2–20 mcg/kg; IV infusion 0.025–0.25 mcg/kg/min. Induction
and maintenance: IV bolus 5–40 mcg/kg. Preoperatively: IM 0.05–0.1 mg
every 30–60 min before surgery. Postoperatively: IM 0.05–0.1 mg every
1–2 hr prn.
haloperidol, Haldol: Antipsychotic agent, typical. Uses: labeled indications:
Management of schizophrenia; control of tics and vocal utterances of
Tourette’s disorder in children and adults; severe behavioral problems
in children. Unlabeled uses: Treatment of non-schizophrenia psychosis;
may be used for the emergency sedation of severely-agitated or delirious
patients; treatment of ICU delirium; adjunctive treatment of ethanol
dependence; postoperative nausea and vomiting (alternative therapy);
psychosis/agitation related to Alzheimer’s dementia. Dosages: Psychosis: PO
0.5–5 mg 2–3 times/day; usual max 30 mg/day. IM (as lactate): 2–5 mg every
4–8 hr as needed. IM (as decanoate): Initial 10–20 times the daily oral dose
administered at 4-wk intervals. Maintenance dose: 10–15 times initial oral
dose; used to stabilize psychiatric symptoms. Delirium in the ICU, treatment
(unlabeled use, unlabeled route): IV initial dose 0.5–10 mg depending on
degree of agitation; if inadequate response, may repeat bolus dose (with
sequential doubling of initial bolus dose) every 15–30 min until calm is
achieved, then administer 25% of the last bolus dose every 6 hr; monitor
ECG and QTc interval. After the patient is controlled, haloperidol therapy
should be tapered over several days. Delirium in the ICU (patients at high
risk of delirium), prevention (unlabeled use, unlabeled route): IV 0.5 mg fol-
lowed by a continuous infusion of 0.1 mg/hr for 12 hr or 0.5 mg every 8 hr.
Rapid tranquilization of severely-agitated patient (unlabeled use; administer
every 30–60 min): PO 5–10 mg. IM (as lactate) 5 mg. Average total dose (oral
or IM) for tranquilization: 10–20 mg. Postoperative nausea and vomiting
(unlabeled use): IM, IV 0.5–2 mg.
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