Short-term analgesia during anesthetic periods, premedication, induction and maintenance; and in the immediate postoperative periods as need arises. Analgesic supplement in general or regional anesthesia. Concomitantly with neuroleptic (eg, droperidol) as an anesthetic premedication, for anesthesia induction and as an adjunct in the maintenance of general and regional anesthesia. As an anesthetic in combination with oxygen in selected high risk patients (eg, undergoing open heart surgery, complicated neurological or orthopedic procedures).
Individualize. Premedication: 50–100mcg (1–2mL) by IM inj 30–60 mins prior to surgery. Adjunct to general anesthesia: see literature. Adjunct to regional anesthesia: 50–100mcg (1–2mL) by IM inj or slow IV (over 1–2 mins), when needed. Post-op: 50–100mcg (1–2mL) by IM inj, may repeat in 1–2 hrs as needed. General anesthetic: 50–100mcg/kg (1–2mL/kg), may administer with oxygen and a muscle relaxant; in certain cases (eg, open heart surgery, complicated neurological or orthopedic procedures), doses up to 150mcg/kg (3mL/kg) may be needed. Elderly, debilitated: reduce dose.
<2yrs: not recommended. 2–12yrs: induction and maintenance: 2–3mcg/kg.
Should be administered only by persons specifically trained in IV anesthetics and respiratory management in an adequate facility. Have an opioid antagonist, resuscitative and intubation equipment, and oxygen readily available. Respiratory depression; monitor closely (esp. post-op). Comatose patients with head injury or brain tumor. Increased intracranial pressure. Hypertension. Pulmonary disease. Renal or hepatic impairment. Cardiac bradyarrhythmias. Drug abuse. Monitor vital signs routinely. Elderly. Debilitated. Premature neonates. Labor & delivery: not recommended. Pregnancy (Cat. C). Nursing mothers.
Caution within 14 days of MAOIs. Cardiovascular depression with nitrous oxide and high-dose fentanyl. Concomitant droperidol may result in decrease in pulmonary arterial pressure and hypotension. Additive effects with other CNS depressants (eg, barbiturates, tranquilizers [eg, diazepam], narcotics, general anesthetics); reduce doses.
Respiratory depression, apnea, skeletal muscle rigidity, bradycardia, hypertension, hypotension, dizziness, blurred vision, nausea, emesis, laryngospasm, diaphoresis.