Episode 65. Let’s Take A Timeout! Procedural Sedation with Quinn Cummings and Benjamin Jackson

PROPOFOL

• Effect: Sedation and amnesia but does not elicit analgesic properties
• Initial Bolus Dosing (IV): 1 mg/kg
• Titration: 0.5 mg/kg every 3-5 min as needed
• Onset of Action IV: Fast  (30-60 seconds)
• Duration of Action: Short (5-10 minutes)
• Adverse Effect: Respiratory depression and hypotension

Ketamine

• Effect: Unique procedural sedation agent, dissociative agent that creates a trance-like state and causes amnesia in patients, analgesic activity
• Initial Bolus Dosing (IV): 1-2 mg/kg
• Titration: 0.5 mg/kg every 5-10 min as needed
• Onset of Action IV: Fast (30-40 s)
• Duration of Action:  Long (60 min)
• Adverse Effect: Dose-related increase in heart rate and blood pressure, increased inotropy causes increased myocardial oxygen demand

MIDAZOLAM

• Effect:  Sedation, retograde amnesia
• Initial Bolus Dosing (IV): 0.1 mg/kg
• Titration: 0.1 mg/kg every 2 min as needed
• Onset of Action IV: Fast (2-5 min)
• Duration of Action: Short (30-80 min)
• Adverse Effect: respiratory depression and hypotension

FENTANYL

• Effect:  Reduction and control of pain
• Initial Bolus Dosing (IV):  0.5-1.5 mcg/kg
• Titration:   0.5-1.5 mcg/kg every 1-3 min as needed
• Onset of Action IV: Rapid (1-2 min)
• Duration of Action:  Short (30-60 min)
• Adverse Effect:  Dose-dependent respiratory depression

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