Opioids Basics Of Anesthesia

Front 1

NUBAIN (nalbuphine)

Back 1

AGONIST/ANTAGONIST
-partial agonist at Kappa and Mu receptors
-less doped up
-has a ceiling effect
REVERSES RESP DEP
***can be better than narcan b/c it still keeps the analgesic effects on board
-can be used for itching

Front 2

STADOL (Butorphanol)

Back 2

AGONIST/ANTAGONIST
-produce analgesia and resp depression similar to 10mg morphine
-more sedative than nalbuphine
-dysphoria is low
-does not increase intrabiliary pressure
***can be used for post op shivering
DOSE 0.5-3 mg IV
-doesn't effect baby like other opioids

Front 3

TREXAN (Naltrexone)

Back 3

ANTAGONIST
-longer acting antagonist PO given for addicts
-may last 24 hours
***pts on this have temporary resistance to narcotics

Front 4

MH

Back 4

1:15,000 children 1:50,000 adults
-hypermetabolic intracellular hyper Ca
-results in intense muscle contraction
-hyperkalemia, increase HR, increase ETCO2, acidosis, increase temp, hypoxemia,
-renal failure, DIC, pulm edema,cerebral edema
- caffeine halothane test req muscle biopsy

Front 5

MH WHAT DO YOU DO?

Back 5

1) HELP
2) Stop all agents stop surgery
3) hyperventilate with 100% O2 to get rid of the rising CO2
-cool the patient, Bicarb 1-2 MEQ/KG, diurese
CV SUPPORT- no Ca channel blockers
DANTROLENE 20mg/50cc sterile water
2.5 mg/kg IV Q 5 min
MAX 10mg/kg
1 mg/kg Q6 hours to prevent recurrence
-dantrolene inhibits further Ca release

Front 6

DILAUDID (HYDROMORPHONE)

Back 6

-similar to morphine
8-10x more potent
no active metabolites
1mg dilaudid = 10 mg morphine
hydromorphone 3- glucuonide metabolite may cause excitation

Front 7

NUBAIN (NALBUPHINE)

Back 7

AGONIST/ANTAGONIST
morphine like analgesia
DOSE 5-10 MG IV or IM
-can cause withdrawal symptoms in pts addicted to opioids

Front 8

FLUMAZENIL

Back 8

BENZO COMPETITIVE ANTAGONIST
reverses anesthetic effects of benzos partially or completely depends on dose
-high affinity for receptor
DOSE 0.2 mg increments do no exceed 1 mg
-can cause seizures
-chronic benzo might be a bad idea

Front 9

NARCAN (NALOXONE)

Back 9

ANTAGONIST
-Mu receptor (competitive antagonist)
-give in 20-40 mcg increments
-reverse resp depression (Mu2)
-no analgesia
peaks in 1-2 min
duration 30-45 min
****abrupt reversal can cause excessive SNS stimulation=> arrhythmias, increase HR, increase BP, N/V, pulm edema
MIX ampule (0.4mg) with 9 cc's of NS
-give 1 cc at a time

Front 10

DEMEROL (MEPERIDINE)

Back 10

DOSE 0.5-1 mg/kg IM
0.2-0.5 mg/kg IV
breaks down into normeperidine
structural similarities to atropine
S/E increase HR, dry mouth, mydriasis (dilation)
used to decrease shivering
EXCRETION kidney
neurotoxic in increase concentration myclonus and seizures
100 mg = 10mg morphine
-do not give in patients taking MAOI'S (NARDIL)

Front 11

MAOI EFFECT INTERACTIONS

Back 11

interaction with demerol
causes a severe excitatory state
increase HR, BP, TEMP
-delerium seizures
-possible death

Front 12

ANECTINE (Succinylcholine)

Back 12

RAPID ONSET 60-90 sec
SHORT DURATION 3-10 min
DOSE 1-1.5 mg/kg IV
4-5 mg/kg IM in children
EXCRETION pseudocholinesterase into succinylmonocholine
****pseudocholinesterase also called plasma cholinesterase

Front 13

FENTANYL

Back 13

-structurally related to demerol
100xs more potent than morphine
DOSE INTRA-OP 2-10 mcg/kg
CT SURG 30-50 mcg/kg
POST OP 0.5-1.5 mcg/kg
I CC = 50 MCGS
E 1/2 3-6 hours
minimal CV EFFECTS
****can cause chest wall rigidity
if you can't ventilate give muscle relaxant

Front 14

SUFENTANYL

Back 14

7-10Xs more potent than fentanyl
DOSE INTRA OP 0.2-0.8 mcg/kg
CT SURG 10-30 mcg/kg
-used for really big cases
E 1/2 2.5-4 hours

Front 15

ALFENTANYL

Back 15

1/5 - 1/10 as potent as fentanyl
INTRA OP DOSE 10-100 mcg/kg
rapid onset shorter duration
E 1/2 1-1.5 hours

Front 16

REMIFENTANYL

Back 16

similar potent to fentanyl
extreme rapid onset, recovery
DOSE 1 mcg/kg IV over 60-90 sec
then 0.25 - 1 mcg/kg or 0.05 -2 mcg/kg/min
***metabolized by non specific plasma and tissue esterases

Front 17

MORPHINE

Back 17

DOSE 0.1-1 mg/kg IV (intra op)
0.05-0.2 mg/kg IM (post op)
0.03-0.015 mg/kg IV (post op)
****histamine release
decrease bp, increaes HR, flushing
metabolite morphine 3 glucuronide and morphine 6 glucuronide.
Morphine 6 glucuronide is active metabolite that is more potent and longer acting
EXCRETION metabolized in liver and excreted by the kidneys