I am inter doctor in Anesthesiology and rhenemation department, create a table for me of medication along with calculation of it's doses as per weight of patient and other factors in Anesthesiology department also add other information which I must know as intern.
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I now have comprehensive data from the top anesthesia textbooks. Let me compile the complete, detailed reference table for you.
Anesthesiology & Resuscitation - Intern Drug Reference Guide
Sources: Miller's Anesthesia 10e, Barash's Clinical Anesthesia 9e, Morgan & Mikhail's Clinical Anesthesiology 7e
SECTION 1 - INTRAVENOUS INDUCTION AGENTS
| Drug | Standard Adult Dose | Elderly / ASA III-IV | Pediatric Dose | Onset | Duration | Key Notes |
|---|---|---|---|---|---|---|
| Propofol | 1.0-2.5 mg/kg IV | 1.0-1.75 mg/kg IV (>60 yrs); ~half dose in >80 yrs | 2.0-3.0 mg/kg IV (ED95) | 30-60 sec | 5-10 min | Reduce dose with premedication (opioid/BZD). Use lean body weight. Causes apnea. Painful on injection. Maintenance infusion: 100-200 mcg/kg/min. |
| Ketamine | 1-2 mg/kg IV / 4-6 mg/kg IM | Reduce 25-30% | IV: 1-2 mg/kg; IM: 4-6 mg/kg; PO/IN: 3-6 mg/kg | 30-60 sec IV; 3-5 min IM | 10-15 min IV; 20-30 min IM | Dissociative anesthetic. Preserves airway reflexes and BP. Bronchodilator. Avoid in head trauma (raises ICP). Co-administer midazolam to prevent emergence delirium. |
| Etomidate | 0.2-0.3 mg/kg IV | 0.15-0.2 mg/kg IV | 0.2-0.3 mg/kg IV | 30-60 sec | 5-15 min | Hemodynamically stable - preferred in shocked/cardiac patients. Single dose causes adrenal suppression. Causes myoclonus. |
| Midazolam | 0.2-0.3 mg/kg IV (induction); 0.04-0.08 mg/kg IV (sedation) | 0.02-0.05 mg/kg IV (sedation); titrate slowly | 0.05-0.15 mg/kg IV; PO premedication: 0.5 mg/kg (max 20 mg) | 2-3 min | 15-30 min | Benzodiazepine. Not used as sole induction agent. Excellent premedication. Reversal: Flumazenil 0.2 mg IV (repeat to max 1 mg). |
| Thiopental | 3-5 mg/kg IV | 1.5-3 mg/kg IV | 5-7 mg/kg IV (neonates 3-4 mg/kg) | 30-60 sec | 5-10 min | Barbiturate. Decreases ICP - historically used in neuro cases. Laryngospasm/bronchospasm risk. Extravasation causes tissue necrosis. |
Propofol dose adjustment: Lean body weight (not actual) for obese patients. Reduce by ~50% in elderly >80 years. - Miller's Anesthesia, 10e
SECTION 2 - OPIOID ANALGESICS
| Drug | Intraoperative Bolus | Infusion Rate | Onset | Duration | Special Notes |
|---|---|---|---|---|---|
| Fentanyl | 1-3 mcg/kg IV | 0.02-0.1 mcg/kg/min | 2-3 min | 30-60 min | Most commonly used perioperative opioid. Blunts laryngoscopy response: give 1-2 mcg/kg 3 min before intubation. Chest wall rigidity at high doses. |
| Morphine | 0.05-0.2 mg/kg IV (titrate) | 0.01-0.04 mg/kg/hr | 15-30 min | 3-5 hr | Histamine release - use cautiously in asthma/hemodynamic instability. Good for postoperative analgesia. |
| Remifentanil | 0.5-1 mcg/kg (over 30-60 sec) | 0.05-0.2 mcg/kg/min | 1-2 min | 3-10 min | Ultra-short acting. Must have a multimodal analgesia plan before stopping infusion. No accumulation. Adjusted for lean body weight. |
| Sufentanil | 0.3-0.7 mcg/kg IV | 0.005-0.01 mcg/kg/min | 1-3 min | 45-90 min | 5-10x more potent than fentanyl. Used in cardiac/major surgery. |
| Alfentanil | 10-30 mcg/kg IV | 0.5-3 mcg/kg/min | 1-2 min | 10-20 min | Rapid onset, shorter than fentanyl. Useful for short procedures. |
| Naloxone (reversal) | 0.04 mg IV q2-3 min; max 0.4-2 mg | - | 1-2 min | 30-45 min | Reverses respiratory depression. Give in small increments to avoid acute pain/hypertensive crisis. Half-life shorter than opioids - re-sedation can occur! |
Opioid dose notes: All opioid infusions should be based on lean/ideal body weight in obese patients. High-dose opioid anesthesia (morphine, fentanyl) historically used for cardiac surgery. - Miller's Anesthesia, 10e
SECTION 3 - NEUROMUSCULAR BLOCKING AGENTS (NMBAs)
Depolarizing
| Drug | Intubation Dose | RSI Dose | Onset | Duration | Notes |
|---|---|---|---|---|---|
| Succinylcholine | 1.0-1.5 mg/kg IV | 1.5 mg/kg IV | 45-60 sec | 8-12 min | Use actual body weight (including in obese patients). Contraindicated in: burn/denervation >48 hrs, hyperkalemia, malignant hyperthermia susceptibility, pseudocholinesterase deficiency, pediatric patients (routine use - use only for laryngospasm/emergency). Preceded by atropine in children. |
Non-Depolarizing (Intermediate Duration)
| Drug | Intubation Dose | Maintenance | Onset | Duration | Reversal |
|---|---|---|---|---|---|
| Rocuronium | 0.6 mg/kg IV | 0.1-0.2 mg/kg bolus | 2-3 min | 30-45 min | Neostigmine OR Sugammadex. RSI dose: 1.2 mg/kg (equivalent to succinylcholine onset) |
| Vecuronium | 0.1 mg/kg IV | 0.01-0.015 mg/kg bolus | 3-4 min | 25-40 min | Neostigmine. Use ideal body weight in obese patients. |
| Cisatracurium | 0.1-0.2 mg/kg IV | 1-3 mcg/kg/min infusion | 3-5 min | 40-60 min | Hofmann elimination - preferred in liver/renal failure. No histamine release. |
| Atracurium | 0.5 mg/kg IV | 0.1-0.2 mg/kg bolus | 2-3 min | 25-35 min | Hofmann elimination. Laudanosine metabolite (seizure risk at very high doses). Releases histamine. |
| Pancuronium | 0.1 mg/kg IV | 0.01 mg/kg | 3-5 min | 60-90 min | Long-acting. Tachycardia (vagolytic). Avoid in renal failure. Largely replaced by intermediates. |
NMBA dosing rule: Succinylcholine = actual body weight; all nondepolarizing agents = ideal body weight. - Barash's Clinical Anesthesia, 9e
NMBA Reversal Agents
| Drug | Dose | Co-administer | Notes |
|---|---|---|---|
| Neostigmine | 0.04-0.07 mg/kg IV (max 5 mg) | Glycopyrrolate 0.01 mg/kg OR Atropine 0.02 mg/kg | Most common reversal. Only effective at TOF count >2. Pediatric dose: 0.05 mg/kg + glycopyrrolate 0.01 mg/kg. |
| Sugammadex | 2 mg/kg (moderate block); 4 mg/kg (deep block); 16 mg/kg (immediate reversal) | No anticholinergic needed | Reverses rocuronium and vecuronium ONLY. Rapid, reliable. Preferred in high-risk patients. |
| Glycopyrrolate | 0.2 mg per 1 mg neostigmine | Given with neostigmine | Does not cross BBB. Preferred over atropine for reversal. |
| Atropine | 0.015-0.02 mg/kg IV | Given with neostigmine | Crosses BBB. Tachycardia. Used when glycopyrrolate unavailable. |
SECTION 4 - INHALATIONAL ANESTHETICS
| Agent | Adult MAC (%) | Pediatric MAC | Blood:Gas Coefficient | Notes |
|---|---|---|---|---|
| Sevoflurane | 1.8-2.0% | ~2.5% (infants) | 0.65 (fast inhalation induction) | Non-pungent - ideal for mask induction (especially children). Nephrotoxicity concern (Compound A) in low-flow circuits. |
| Desflurane | 6.0-7.3% | ~9.0% (infants) | 0.45 (fastest emergence) | Pungent - NOT for inhalation induction (laryngospasm). Fastest wake-up. Causes sympathetic stimulation on rapid increase. |
| Isoflurane | 1.15-1.2% | ~1.6% (infants) | 1.4 | Standard volatile agent. Coronary steal controversy (largely historical). |
| Nitrous Oxide | ~105% MAC (subanesthetic doses) | Same | 0.47 | Analgesic, anxiolytic. Always combine with other agents. Avoid in: pneumothorax, bowel obstruction, middle ear surgery, vitamin B12 deficiency. |
MAC decreases with: age, hypothermia, opioids, sedatives, pregnancy. MAC increases with: hyperthermia, chronic alcohol use, hypernatremia. - Miller's Anesthesia, 10e
SECTION 5 - LOCAL ANESTHETICS
| Drug | Maximum Dose (Plain) | Max Dose (+ Epinephrine) | Onset | Duration | Uses |
|---|---|---|---|---|---|
| Lidocaine | 3-4 mg/kg | 7 mg/kg | Fast | 60-120 min | Infiltration, nerve block, spinal (5% hyperbaric), topical, IV for arrhythmia. Systemic toxicity antidote: 20% lipid emulsion. |
| Bupivacaine | 2 mg/kg (max 175 mg) | 3 mg/kg (max 225 mg) | Intermediate | 3-10 hr | Spinal (0.5% hyperbaric), epidural, nerve blocks. Cardiotoxic - never use IV. Avoid in pediatric IV regional (Bier block). |
| Ropivacaine | 3 mg/kg (max 200 mg) | - | Intermediate | 3-8 hr | Epidural, nerve blocks. Less cardiotoxic than bupivacaine. Produces motor/sensory differential block. |
| Prilocaine | 5 mg/kg | 8.5 mg/kg | Fast | 1-3 hr | EMLA cream component. Methemoglobinemia risk at high doses. |
| Cocaine | 3 mg/kg topical only | - | Fast | 20-30 min | Topical ENT/nasal only. Vasoconstrictor. Only local anesthetic that causes vasoconstriction. |
LAST (Local Anesthetic Systemic Toxicity): Treat with 20% lipid emulsion - initial bolus 1.5 mL/kg IV, then infusion 0.25 mL/kg/min. Avoid propofol as substitute. - Miller's Anesthesia, 10e
SECTION 6 - VASOPRESSORS & CARDIOVASCULAR DRUGS
| Drug | Dose | Route | Indication | Notes |
|---|---|---|---|---|
| Epinephrine | ACLS arrest: 1 mg IV q3-5 min; Anaphylaxis: 0.3-0.5 mg IM (1:1000); Infusion: 0.01-0.5 mcg/kg/min | IV / IM | Cardiac arrest, anaphylaxis, severe bronchospasm | Central line preferred for infusion. Alpha + Beta agonist. |
| Norepinephrine | 0.01-0.3 mcg/kg/min | IV infusion | Vasodilatory shock, post-induction hypotension | Predominantly alpha. First-line vasopressor in septic shock. |
| Vasopressin | 0.03-0.04 units/min (fixed dose) | IV infusion | Vasodilatory/refractory shock; ACLS second-line | Non-adrenergic vasoconstriction. Useful in catecholamine-refractory shock. |
| Phenylephrine | Bolus: 50-200 mcg IV; Infusion: 0.5-2 mcg/kg/min | IV | Hypotension (spinal anesthesia, induction) | Pure alpha agonist. Raises SVR and MAP. Reflex bradycardia. Preferred in pregnancy. |
| Ephedrine | 5-25 mg IV bolus | IV | Mild-moderate hypotension, spinal hypotension | Mixed alpha/beta. Crosses placenta. Tachyphylaxis. |
| Atropine | 0.4-0.6 mg IV; pediatric: 0.02 mg/kg (min 0.1 mg, max 0.5 mg) | IV | Bradycardia, NMBA reversal | Anticholinergic. Below 0.1 mg can cause paradoxical bradycardia in children. |
| Dopamine | 2-20 mcg/kg/min | IV infusion | Cardiogenic shock, bradycardia | Dose-dependent receptors: 1-3 (DA), 3-10 (beta), >10 (alpha). |
| Dobutamine | 2-20 mcg/kg/min | IV infusion | Low cardiac output, cardiogenic shock | Beta-1 predominant. Positive inotropy. May cause hypotension via vasodilation. |
SECTION 7 - ANTIEMETICS (PONV Prophylaxis)
| Drug | Dose | Timing | Notes |
|---|---|---|---|
| Ondansetron | 4 mg IV | End of surgery | 5-HT3 antagonist. First line PONV prophylaxis. QT prolongation at high doses. |
| Dexamethasone | 4-8 mg IV | Induction | Most effective when given at induction. Synergistic with ondansetron. |
| Metoclopramide | 10-20 mg IV | Before/after surgery | D2 antagonist. Also promotility. Extrapyramidal side effects. |
| Droperidol | 0.625-1.25 mg IV | End of surgery | Highly effective. QT prolongation - requires ECG monitoring per FDA black box. |
| Dimenhydrinate | 1 mg/kg IV | - | H1 blocker. Sedation. |
SECTION 8 - RAPID SEQUENCE INTUBATION (RSI) PROTOCOL
The RSI sequence (the "7 Ps"):
- Preparation - equipment, suction, IV access, drugs drawn
- Preoxygenation - 100% O2 for 3-5 min (or 8 vital capacity breaths)
- Pre-treatment - (optional: fentanyl 1-3 mcg/kg for hemodynamic blunting, lidocaine 1.5 mg/kg for ICP, atropine in children)
- Paralysis + Induction - give simultaneously:
- Etomidate 0.3 mg/kg + Succinylcholine 1.5 mg/kg (standard RSI)
- OR Ketamine 1-2 mg/kg + Rocuronium 1.2 mg/kg (SRSI or where succinylcholine contraindicated)
- Positioning - sniffing position; Sellick's maneuver (cricoid pressure) - controversial
- Placement of tube + CO2 confirmation
- Post-intubation management - secure tube, CXR, sedation infusion
SECTION 9 - MALIGNANT HYPERTHERMIA (MH) - EMERGENCY PROTOCOL
| Step | Action |
|---|---|
| Stop trigger | Halt all volatile agents (sevoflurane, desflurane, isoflurane); stop succinylcholine |
| Dantrolene | 2.5 mg/kg IV bolus IMMEDIATELY; repeat 1 mg/kg q5-10 min to max 10 mg/kg |
| Hyperventilate | 100% O2 at high flow, 3x minute ventilation to clear CO2 |
| Cooling | Ice packs, cold IV fluids, surface cooling; target temp <38.5°C |
| Treat hyperkalemia | Sodium bicarbonate, calcium gluconate, insulin + glucose |
| Treat arrhythmias | Procainamide (NOT calcium channel blockers) |
| Maintain urine output | > 1 mL/kg/hr; give IV fluids; consider furosemide |
Dantrolene dose: 2.5 mg/kg IV, repeat every 5-10 min as needed. Total dose may exceed 10 mg/kg in severe cases. Reconstitute each 20 mg vial with 60 mL sterile water.
SECTION 10 - ANAPHYLAXIS UNDER ANESTHESIA
| Drug | Dose | Route |
|---|---|---|
| Epinephrine (1st line) | 0.1-0.5 mg IV (titrate in 0.05 mg increments); if no IV: 0.3-0.5 mg IM (1:1000) | IV preferred intraoperatively |
| Diphenhydramine | 1 mg/kg IV (max 50 mg) | IV |
| Hydrocortisone | 200-400 mg IV | IV |
| Albuterol | 2.5-5 mg nebulized | Inhaled |
| Norepinephrine infusion | 0.1-0.5 mcg/kg/min | IV infusion if vasopressor-dependent |
SECTION 11 - KEY PHARMACOLOGY PRINCIPLES FOR INTERNS
Body Weight Adjustments (Critical!)
| Weight Used | Drugs |
|---|---|
| Actual Body Weight (ABW) | Succinylcholine, propofol (use lean), ketamine |
| Ideal Body Weight (IBW) | All nondepolarizing NMBAs, fentanyl infusions, many antibiotics |
| Lean Body Weight (LBW) | Propofol induction and maintenance |
| IBW formula (Devine) | Male: 50 + 2.3 kg per inch >5 ft; Female: 45.5 + 2.3 kg per inch >5 ft |
Age Adjustments
- Elderly (>65 yrs): Reduce propofol, thiopental, and opioid doses by 25-50%. Slower drug metabolism, reduced cardiac output, reduced protein binding.
- Pediatric: Propofol induction ED95 = 2-3 mg/kg (higher). MAC values for volatiles are highest in infants (1-6 months). Succinylcholine not for routine pediatric use (risk of hyperkalemia in undiagnosed myopathies).
- Neonates: Neostigmine 0.07 mg/kg for NMBA reversal; 90% reversal takes ~10 minutes.
ASA Physical Status Classification (Mandatory Pre-op Assessment)
| Class | Description | Example |
|---|---|---|
| ASA I | Healthy | No comorbidities |
| ASA II | Mild systemic disease | Controlled HTN, DM, smoker |
| ASA III | Severe systemic disease | Uncontrolled DM, CHF, COPD |
| ASA IV | Severe, life-threatening | Recent MI, severe CHF |
| ASA V | Moribund | Not expected to survive without surgery |
| ASA VI | Brain-dead (organ donation) | |
| Suffix "E" | Emergency surgery | e.g., ASA IIE |
Intraoperative Monitoring (Minimum Standards)
- Continuous ECG
- Pulse oximetry (SpO2)
- Non-invasive blood pressure (NIBP) every 5 min
- Capnography (EtCO2) - mandatory when intubated
- Temperature (recommended for all >30 min cases)
- Oxygen analyzer
- Nerve stimulator (TOF) when using NMBAs
Common Intraoperative Drug Calculations Example
Patient: 70 kg adult, 45 years old, ASA II, elective laparoscopic cholecystectomy
| Drug | Calculation | Dose to Give |
|---|---|---|
| Propofol induction | 1.5 mg/kg x 70 kg | 105 mg |
| Fentanyl pre-intubation | 2 mcg/kg x 70 kg | 140 mcg |
| Rocuronium intubation | 0.6 mg/kg x 70 kg | 42 mg |
| Succinylcholine (if RSI) | 1.5 mg/kg x 70 kg | 105 mg |
| Neostigmine reversal | 0.05 mg/kg x 70 kg | 3.5 mg |
| Glycopyrrolate with neo | 0.01 mg/kg x 70 kg | 0.7 mg |
| Ondansetron PONV | 4 mg fixed | 4 mg |
| Dexamethasone PONV | 8 mg fixed | 8 mg |
SECTION 12 - WHAT EVERY INTERN MUST KNOW
10 Things You Must Do Before Every Anesthetic
- Check the STOPBANG score (OSA screening) and airway assessment (Mallampati, mouth opening, thyromental distance, neck mobility)
- Review allergies especially to latex, antibiotics, NMBAs (cross-sensitivity possible)
- Confirm NPO status (2 hr clear fluids, 6 hr light meal, 8 hr fatty meal)
- Draw up all drugs labeled before induction; double-check with a second person
- Check anesthesia machine using the standard pre-use checklist
- Confirm IV access is working and adequately sized (at least 18G for most adults)
- Know the difficult airway backup plan (video laryngoscope, LMA, surgical airway)
- Confirm reversal agents are available before giving NMBAs
- Suction running and working at bedside
- Have emergency drugs drawn: epinephrine 100 mcg/mL syringe, atropine 0.6 mg/mL
Dangerous Drug Combinations to Avoid
| Combination | Risk |
|---|---|
| Succinylcholine + volatile agents | Malignant hyperthermia trigger |
| High-dose fentanyl rapid bolus | Chest wall rigidity ("wooden chest") |
| Bupivacaine IV | Fatal cardiac arrest |
| Calcium channel blockers + dantrolene | Hyperkalemia, myocardial depression |
| MAOIs + opioids (esp. meperidine) | Serotonin syndrome / hypertensive crisis |
| Ketamine + high ICP | Raises ICP - use cautiously with controlled ventilation |
Fluids in the OR
| Fluid | Indication | Rate |
|---|---|---|
| Normal Saline (0.9%) | Hypochloremia, blood product dilution, neurosurgery | 10-15 mL/kg/hr maintenance |
| Lactated Ringer's | General maintenance, large volume | 10-15 mL/kg/hr |
| Colloid (Albumin 5%) | Volume resuscitation when crystalloid fails | 250-500 mL boluses |
| Blood (PRBC) | Hb threshold: <7 g/dL (8 g/dL in cardiac patients) | 1 unit raises Hb ~1 g/dL |
All doses verified from: Miller's Anesthesia, 10e (PMID); Barash's Clinical Anesthesia 9e; Morgan & Mikhail's Clinical Anesthesiology 7e. Always verify doses at the bedside and against your institution's protocols. Clinical judgment supersedes any reference table. Drug dosing in special populations (renal/hepatic failure, neonates, pregnancy) requires additional individualized calculation.
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