Epistemis

Comparative Table of the Anesthetic Vademecum

  • Synthesis Analysis and Quick Adjustment Guidelines

This vademecum concludes by unifying the main pharmacological agents used in general clinical anesthesia, facilitating the rapid analysis of their kinetic properties and cardiovascular profiles by the specialist.

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Drug Name Family / Class Usual Dose (IV/Inhaled) Clinical Hazard / Major ADR Dose Adjustment in Special Populations
Sevoflurane Halogenated Inhalation 1.8% - 2.0% MAC Malignant hyperthermia / Compound A nephritis Reduce inspired concentration by 30% - 40% in the elderly.
Propofol Intravenous Inducer 1.5 - 2.5 mg/kg IV Severe arterial hypotension / PRIS syndrome Reduce induction dose in ASA class III/IV patients and the elderly.
Sodium Thiopental Barbiturate Inducer 3.0 - 5.0 mg/kg IV Reflex laryngospasm / Porphyria crisis Reduce dose in hypoalbuminemia and severe uremia.
Etomidate Imidazole Inducer 0.2 - 0.3 mg/kg IV Adrenal suppression of cortisol / Myoclonus No renal adjustment required; Avoid in prolonged sepsis.
Ketamine Dissociative Anesthetic 1.0 - 2.0 mg/kg IV Delirium upon awakening / Sympathetic tachycardia Avoid in decompensated coronary heart disease and active schizophrenia.
Dexmedetomidine Alpha-2 Adrenergic Agonist 0.2 - 1.4 µg/kg/h Extreme bradycardia / AV heart block Reduce maintenance dose by 50% in decompensated liver cirrhosis.
Remifentanil Synthetic Opioid Agonist 0.05 - 0.5 µg/kg/min Thorax in wood / Immediate respiratory apnea No change in renal failure; It does not accumulate in long infusions.
Succinylcholine Depolarizing BNM 1.0 - 1.5 mg/kg IV Fatal hyperkalemia / Painful fasciculations Absolutely contraindicated in denervation, extensive burns and myopathies.
Cisatracurium Non-Depolarizing BNM 0.15 - 0.2 mg/kg IV Prolonged effect in extreme hypothermia Relaxant of absolute choice in terminal renal and hepatic failure.
Sugammadex BNM Reverter 2.0 - 16.0 mg/kg IV Transient sinus bradycardia / Skin allergy Not recommended in GFR < 30 mL/min due to slow renal elimination of the complex.
Lidocaine Local Anesthetic (Amide) Up to 4.5 mg/kg single LAST (Neuro-cardiac systemic toxicity) Reduce maximum infiltration dose in cirrhotic patients.
Bupivacaine Local Anesthetic (Amide) Up to 2.0 mg/kg single LAST of fatal refractory cardiac character Do not inject intravenously; contraindicated for intravenous regional blocks (Bier).

Three Fundamental Guidelines of the Anesthetic Vademecum

  1. The axonal pH factor: The onset of action and analgesic efficacy of local anesthetics is directly determined by the neutral ionization ratio dependent on the acidity of the local tissue.
  2. Gas myelotoxicity: Prolonged exposure to nitrous oxide compromises the cellular synthesis of myelin and folates due to the irreversible oxidation of the cobalt group of vitamin B12.
  3. The lipid rescue route: Given the initial clinical suspicion of systemic toxicity due to local anesthetics (LAST) accompanied by bradycardia or refractory malignant arrhythmias, the early initiation of 20% lipid infusion therapy is a priority over traditional cardiac support maneuvers.

The judgment of the clinical anesthesiologist coordinately integrates tricompartmental cellular modeling, control of sympathetic transmission, and rapid reversal of neuromotor blocks for the benefit of perioperative patient safety.

Epistemis is educational review material. It is not a medical device, does not diagnose or prescribe treatment, and does not replace formal medical training, current clinical guidelines, or professional clinical judgment.

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Synthesis Analysis and Quick Adjustment Guidelines
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