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Last Updated on May 30, 2022

wdt_ID Medication Dose - IV Onset Duration Class Action Advantages Disadvantages Adverse Effect Antidote Precaution
1 Propofol Procedural sedation (adult)
• 0.5 - 1 mg / kg (repeat every 1 - 2 minutes until desired effect)
• Half dose if >65 yrs
IV: 40 seconds IV: 6 mins • Rapid onset & recovery• Sedative & amnesic effetcs • No analgesia properties • C&S and respiratory depression, especially when used with opioids • Contraindicated in soy / egg allergies
2 Midazolam Procedural sedation (adult)
• 0.1 mg / kg in divided doses

Procedural sedation (paeds)
• 0.05 mg / kg in divided doses (max 2 mg if
IV: 2 - 5 mins IV: 30 - 60 mins Benzodiazepine • Anxiolytic properties• Sedative & amnesic effects • No analgesia properties • C&S and respiratory depression, especially when used with opioids• Hypotension Flumazenil
3 Ketamine Procedural sedation (adult)
• 1 - 2 mg/kg, followed by 0.25 - 0.5 mg/kg every 5 - 10 mins

Procedural sedation (paeds)
• 1 mg/kg slow bolus
IV: 30 seconds IV: 10 - 20 mins • Bronchodilatation • Fairly safe• Side effects rare• Sedative + analgesic properties• Dissociative amnesic• Useful in asthma patients (bronchodilator effect) • Laryngospasm with large doses (uncommon) • In paeds, use in conjunction with atropine to decrease secretions
4 Fentanyl Procedural sedation (adult)
• 0.5 - 1 µg/kg, then every 2 mins till appropriate level of analgesia (max 2 µg/kg)
• Half dose in elderly
• Usual dose: 50 µg stat

Procedural sedation (paeds)
• 0.5 µg/kg every 2 mins (max 2 µg/kg)
IV: 2 - 3 mins IV: 30 - 60 mins Analgesia • Rapid analgesic effect• Minimal histamine release (anaphylactoid reaction)• Short duration• No intermediate metabolites (therefore ideal analgesic for patients with chronic renal / liver disease) • Respiratory depression with concurrent use of sedative• Chest wall rigidity with large doses• Hypotension (uncommon) • For use in combination with propofol & midazolam, to give Fentanyl 15 mins before sedatives
5 Morphine Procedural sedation (adult)
• 0.1 - 0.2 mg/kg in divided doses
• Half dose in elderly

Procedural sedation (paeds)
• 0.01 - 0.04 mg/kg in divided doses
IV: >5 mins 3 - 4 hours Opioid analgesia • Can be titrated • Slow onset with prolonged action• Causes histamine release • Respiratory & CNS depression• Vomiting Naloxone • For use in combination with propofol & midazolam, to give Fentanyl 15 mins before sedatives
6 Naloxone Adult
• IV 0.2 mg over 15 seconds
• If no response after 1 min, repeat with 0.3 mg
• If no response after 1 min, repeat with 0.5 mg
• Repeat till max cumulative dose of 5 mg/hr

Paeds
• IV 0.01 mg/kg every 1 hour
IV: 1 min IV: 45 mins • Fairly safe
7 Flumazenil Adult
100 µg every 2 - 3 mins till reversal

Paeds
0.1 mg
IV: 1 - 2 mins IV: 10 - 15 mins • Fairly safe • Half life shorter than benzodiazepine half life
8 Clotrimazole (Canesten) Antifungal
9
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Medication Onset Duration Class Action Advantages Disadvantages Adverse Effect Antidote Precaution

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