Down the K Hole via the A Hole

 

Following on from Cliff Reid’s talk “Scoop and Run is for A Holes “yesterday at Essentials of Emergency Medicine, today we Michael Levine  gave a talk that could have been called “Down the K hole via the A hole”

His talk was on alternative routes of administration for sedative and anaesthetic drugs.

Personally, when I haven’t got an IV line, I like fentanyl IN but otherwise I like to drugs IM so I know how much has actually been absorbed.  Unless it’s a really short procedure I’ll usually place an IV line once the kid is under because if you have to redose IM the patient will sleep for hours.

DRUG

INTRANASAL DOSE

Fentanyl

1.5-3 mcg/kg

Ketamine

8-9 mg/kg

Midazolam

0.5 mg/kg

Naloxone

0.005-0.1mg/kg

Sufentanil

0.2-1 mcg/kg

 

It’s good to see that fentanyl dose is creeping up.  A few years ago it was 1.5µg/kg which never seemed to cut it, then it was 2µg/kg which was sort of OK, but now 3µg/kg is sounding better).  And the few times I’ve used IN ketamine it’s been pretty rubbish – but I was using 5mg/kg so I was under dosing.

(Note: Michael Levine left the nalaxone dose blank.  I’ve added the dose from Pedistat.  The lower dose is for reversal of anaesthesia, the highest dose to reverse an overdose)

But I hadn’t even thought about giving rectal ketamine.

 

DRUG

RECTAL DOSE

Diazepam

0.75 mg/kg

Ketamine

10 mg/kg

Methohexital

25-30 mg/kg

Midazolam

0.3-1 mg/k

 

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