Reading materials for conscious sedation - Yale-New Haven Hospital

APPENDIX AP R E F E R R E D A G E N T SU N R E S T R I C T E D S E D A T I O N A G E N T STypical Pediatric dose Typical Adult dose ConsiderationsAgent Route Onset(min)Midazolam(Versed®)Fentanyl(Sublimaze®)Duration(hr)IV 1-5 0.5-1.5PO 10-15PR 10-30IntranasalIVTransmucosa5-30l3-5 0.5-1.06mo-5yo pt: 0.05-0.1 mg/kg/dose, max 1mg; may repeat q3-5min to max total doseof lesser of 0.6 mg/kg or 6 mg6-12yo pt: 0.025-0.05 mg/kg/dose, max 2.5mg; may repeat q3-5min to total dose oflesser of 0.4 mg/kg or 10 mg.1-2 6mo-40 kg pt: 5 mcg/kg.Dose rarely to exceed 400 mcg.0.5-2.5mg/dosemay repeat q3-5 min, total doserarely to exceed 10mg.Not routinely given to adultsNot routinely given to adultsNot routinely given to adults25-50 mcg/dose; may repeat q1-2min. Patients not responding to a 50mcg dose may receive 100 mcgrepeat doses. Total dose >200 mcgrarely needed for short procedures;patients undergoing prolongedprocedures (i.e. >45 min) mayrequire up to 400 mcg total dose.Not routinely given to adultsPREFERRED BENZODIAZEPINEReversible with flumazenil.Administer slowly over at least 2minutes to avoid respiratorydepression or apnea.Use smaller doses in debilitated,chronically ill, elderly, or patients withdecreased pulmonary or cardiovascularreserve.Patients with chronic benzodiazepineor alcohol use may require higherdoses.Respiratory depression ispotentiated when combined with anarcotic.PREFERRED OPIATEReversible with naloxone.Use smaller doses in debilitated,chronically ill, elderly, or patients withdecreased pulmonary/cardiovascularreserve.Respiratory depression ispotentiated when combined with abenzodiazepine.Administer slowly over 3-5 minutesto avoid chest wall rigidity.