Sedative-hypnotic
|
Midazolam |
Sedation, motor control, anxiety reduction, no analgesic effect |
Hypotension, respiratory depression, paradoxical effect |
Procedures that require sedation, Reduced anxiety or amnesia |
IV (age 6 months-5 years): initial 0.05-0.1 mg/kg, maximum of 0.6 mg/kg IV (6-12 years): initial 0.025-0.05 mg/kg, maximum of 0.4 mg/kg IM: 0.1-0.15 mg/kg PO: 0.5-0.75 mg/kg IN: 0.2-0.5 mg/kg RR: 0.25-0.5 mg/kg |
2-3 min
2-3 min
10-20 min 15-30 min 10-15 min 10-30 min |
45-60 min
45-60 min
60-120 min 60-90 min 60 min 60-90 min |
Diazepam |
Sedation, motor control, anxiety reduction, no analgesic effect |
Hypotension, respiratory depression, paradoxical effect |
Seldom used due to long half-life |
IV: initial 0.05-0.1 mg/kg, Max 0.25 mg/kg |
2-3 min |
45-60 min |
Propofol |
Fast and short sedation |
May cause pain at infusion, hypotension, apnea and bradycardia |
Short-term procedures, associated or unassociated with analgesics |
IV: 1-2 mg/kg, may repeat 0.5 mg/kg every 3-5 min |
1 min |
5-15 min |
Etomidate |
Fast and short sedation |
May cause local pain, myoclonus, transient adrenal suppression |
Short-term procedures, associated or unassociated with analgesics |
IV: 0.2-0.3 mg/kg |
30-60 s |
5-15 min |
Dexmedetomidine |
Sedation with respiratory drive maintenance Does not change EEG tracing Off-label use in pediatrics |
May cause arrhythmia, hypotension, and hypertension |
Imaging procedures (CT and MRI), endoscopy, EEG |
IV: 2 mcg/kg IN/oral mucosa: 1-3 mcg/kg IM: 1-4.5 mcg/kg Oral: 5 mcg/kg |
5-10 min |
60-120 min |
|
Analgesics
|
Fentanyl |
Analgesia |
Bradycardia, chest stiffness, respiratory depression |
Procedures with moderate to severe pain |
IV: 1.0 µg/kg/dose, may be repeated every 3 min IN: 1.5 µg/kg/dose |
2-3 min
2-5 min |
30-60 min
30-60 min |
Morphine |
Analgesia |
Release of histamine, hypotension, nausea, reduction of gastrointestinal motility |
Procedures with moderate to severe pain |
IV: initial 0.05-0.15 mg/kg, may be repeated every 5 min |
5-10 min |
30-60 min |
Ketamine |
Dissociative agent with analgesic and sedative properties |
Laryngospasm, hypersalivation, emergency reactions, vomiting |
Short-term painful procedures or when amnesia is desired |
IV: 1-2 mg/kg, may repeat 0.5-1 mg/kg every 5-10 min IM: 2-5 mg/kg, may repeat 2-4 mg/kg after 10 min IN: 1-9 mg/kg |
IV: 1 min IM: 3-5 min |
IV: 15 min (dissociation), 60 min (recovery) IM: 15-30 min (dissociation), 90-150 min (recovery) |
|
Antidotes
|
Flumazenil |
Benzodiazepine antagonist |
Increased intracranial pressure, reduction of convulsive threshold |
Reversal of unwanted effects |
IV: 0.02 mg/kg/dose, may be repeated at each min up to a maximum of 1 mg |
1-2 min |
30-60 min |
Naloxone |
Opioid antagonist |
Nausea, anxiety, sympathetic stimulation, hypertension, tachycardia, pulmonary edema, return of pain |
Reversal of unwanted effects |
IV or IM: 0.1 mg/kg/dose, maximum 2 mg/dose; can be repeated every 2 min if necessary
|
IV: 2 min IM: 10-15 min |
IV: 20-40 min IM: 60-90 min |