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 |
