Uses, Doses

GOOD choice for RAPID induction in patient in precarious hemodynamic balance; perhaps especially one with ischemic heart disease, with or without intracranial pathology; or perhaps whenever hemodynamic stability is most important.
Examples:

• Rapid-sequence induction-intubation for intracranial bleed in patient with angina (will need some narcotic or other agent to blunt response to intubation).
• IV sedation vs general anesthesia for short peripheral procedure on patient with mod-severe cardiomyopathy (e.g. cardioversion)

• Induction 0.2 - 0.4 mg/kg (less after pre-med) IV
• Rectal induction (peds) 6.5 mg/kg -> hypnosis in 4 min (stable hemodynamics, rapid recovery)
• Maintenance:
  • Need 300 - 500 ng/ml plasma level
  • Note: "TECHNIC OF TENS":
    10x10 = 100 ug/kg/min for 10 mins then
    10 ug/kg/min and D/C 10 mins before awake
    (LOC usually occurs in 10x10 = 100 secs)
    Expect: hemodynamic stability, adequate spontaneous ventilation, less pain, myoclonus, phlebitis
  
  
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