Uses, Doses

Induction and Maintenance of General Anesthesia

• Induction: 1-2.5 mg/kg
• Maintenance: 50-200 mcg/kg/min +/- N₂O or opioid or ketamine
• ED₉₅ 2.25-2.5 mg/kg
• Onset 1 arm-brain time
• Duration: 3-6 minutes
• Pediatrics: not much change
  • maybe 3 mg/kg induction dose in healthy young children
  • slightly higher maintenance doses may be expected
• Fast recovery and return of psychomotor function
  • within 8-10 minutes after up to 2 hours infusion
  • almost as fast as desflurane and with less nausea and vomiting
• Cardiac surgery
  • not associated with hypotension if boluses are avoided
  • no change in coronary sinus flow, MVO₂, or myocardial lactate extraction
• Cp required: 2.5-6 mcg/ml
• TIVA: propofol + ketamine
  • propofol:ketamine = 4:1 (or even 8:1 for less painful procedures)
  • stable hemodynamics
  • no negative dreaming or abnormal behavior

Sedation

• Readily titratable, rapid recovery, by infusion
• ICU: 4 days sedation ->
  • 10 minutes to recover
  • Cp for sedation stable 96 hours (no tolerance)
• 25-60 mcg/kg/min
• amnesia - yes
• compared to midazolam
  • equal or better control
  • more rapid recovery (and extubation)
• PCS, patient controlled sedation, has been reported effective

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