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UF Health University of Florida
Department of Anesthesiology College of Medicine
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Education Overview

Drugs

Common Drugs
Analgesics
Prophylactic Antibiotic Administration

Common Drugs

Intravenous Agents

* Denotes medication that needs to be diluted when drawn-up

Induction Agents/Adjuncts

Medication Syringe Usual Conc. Dose Notes
Etomidate 20 mL 2 mg/mL 0.2-0.3 mg/kg Typical induction 14-20 mg
Propofol 20 mL 10 mg/mL 2-3 mg/kg Typical induction 120-200 mg
Fentanyl 5 mL 50 ÎĽg/mL 1-1.5 ÎĽg/kg Typical induction 100-150 ÎĽg
Ketamine 5 mL 10 mg/mL 1-2 mg/kg Multimodal induction 15-30 mg
Lidocaine 5 mL 10 mg/mL 0.5-1 mg/kg Typical induction 50 mg
Midazolam 3 mL 1 mg/mL 1-2 mg Typical pre-medication 2 mg

Neuromuscular Blocking Agents/Reversal Agents

MEDICATION SYRINGE USUAL CONC. DOSE NOTES
Cisatracurium 10 mL 2 mg/mL 0.1 mg/kg
Rocuronium 5 mL 10 mg/mL 0.6-1.2 mg/kg Typical intubation 30-50 mg
Succinylcholine 10 mL 20 mg/mL 1-1.5 mg/mL RSI: 100-150 mL
Vecuronium 10 mL 1 mg/mL 0.1 mg/kg Typical intubation 5-10 mg
Glycopyrrolate 5 mL 0.2 mg/mL 0.2-0.9 mg Given 1 mL:1 mL with neostigmine
Neostigmine 5 mL 1 mg/mL 1-4 mg Given w/glycopyrrolate
Sugamadex 2 mL-5 mL 100 mg/mL 2-4 mg/kg 2 mg/kg if 2 twitches; 4 mg/kg if 0 twitch

Antiemetics

MEDICATION SYRINGE USUAL CONC. DOSE NOTES
Metaclopramide 3 mL 10 mg/mL 10 mg Slow IV push or in IV bag
Ondansetron 3 mL 2 mg/mL 4 mg

Vasoactive Agents

MEDICATION SYRINGE USUAL CONC. DOSE NOTES
Ephedrine* 10 mL 5 mg/mL 5-10 mg Single dilution
Phenylephrine* 10 mL 67-100 ÎĽg/mL 50-100 ÎĽg Double dilution
Vasopressin* 20 mL 1 unit/mL 1 unit Single dilution
Esmolol 10 mL 10 mg/mL 10-30 mg
Labetalol 10 mL 5 mg/mL 5-15 mg
Metoprolol 5 mL 1 mg/mL 1-5 mg ––

Other Agents

MEDICATION SYRINGE USUAL CONC. DOSE NOTES
Dexamethasone 3 mL 2 mg/mL 4-8 mg

Intravenous Infusions

MEDICATION USUAL CONC. Preparation Starting Dose
Clevidipine 500 ÎĽg/mL N/A 1 mg/kg/hr
Dobutamine 1,000 ÎĽg/mL 250 mg in 250 mL of D5W or NS 2-20 ÎĽg/kg/min
Dopamine 1,600 ÎĽg/mL 400 mg in 250 mL of D5W 5-20 ÎĽg/kg/min
Epinephrine 16 ÎĽg/mL 4 mg in 250 mL of D5W or NS 0.01-0.2 ÎĽg/kg/min
Nicardipine 0.1 mg/mL 25 mg in 250 mL NS 5-15 mg/hr
Nitroglycerine 200 ÎĽg/mL 50 mg in 250 mL D5W or NS 0.1-1 ÎĽg/kg/min
Norepinephrine 16 ÎĽg/mL 4 mg in 250 mL of D5W or NS 0.01-0.2 ÎĽg/kg/min
Phenylephrine 100 ÎĽg/mL 10 mg in 100 mL NS 0.1-1.5 ÎĽg/kg/min
Vasopressin 1 unit/mL 100 units in 100 mL NS 0.03-0.04 units/min
Dexmedetomidine 5 ÎĽg/mL 200 ÎĽg in 40 mL NS 0.1-0.7 ÎĽg/kg/hr
Propofol 10 mg/mL N/A 20-300 ÎĽg/kg/min
Remifentanyl 50 ÎĽg/mL 1 mg in 20 mL NS 0.1-1.5 ÎĽg/kg/min
Sufentanil 5 ÎĽg/mL 50 ÎĽg in 10 mL NS 0.1-1.5 ÎĽg/kg/hr

Analgesics

Non-Opioid Analgesics

Generic Name Trade Name (Examples) Duration Initial Dose
Tramadol 50 mg Ultram Every 4 hours 1-2 tabs, max 8 tabs/day. Max dose is 400 mg/day
Tramadol 37.5 mg; Acetaminophen 325 mg Ultracet (non-formulary – not available) Every 4 hours 1-2 tabs, max 8 tabs/day or 300 mg/day Tramadol and 2600 mg/day Acetaminophen

Opioid Equianalgesic Conversion Table (Short Acting)

Generic Name Trade Name (Examples) Equianalgesic Dosing Minimum Duration Initial Dose (Opioid Naive)
Codeine Parenteral form (non-formulary – not available) 120 mg SC/IM; 200 mg PO 3 hours 15-60 mg
Hydrocodone and Acetaminophen Vicodin, Lortab, Lorcet (2.5-10 mg HC); always with acetaminophen or ibuprofen 30 mg PO 3 hours 1-2 tabs
Hydromorphone Dilaudid 1.5 mg SC/IV; 7.5 mg PO 2 hours 1-2 mg SC/IV; 1-4 mg PO
Morphine Sulfate immediate release Roxanol 10 mg SC/IV; 30 mg PO 2 hours 2-15 mg IV; 10-30 mg PO
Oxycodone immediate release Roxicodone, Oxyfast, also in Percocet, Percodan, Tylox, Roxicet 20 mg PO 3 hours 5-10 mg PO; max 8 tabs (for acetaminophen)

Opioid Equianalgesic Conversion Table (Fast Acting)

Generic Name Trade Name (Examples) Equianalgesic Dosing Minimum Duration Initial Dose (Opioid Naive)
Fentanyl transdermal Duragesic (do not use for opioid naive patients) available as 25, 50, 75, 100 mcg/hour patches follow conversion charts from manufacturer 48 hours 25 mcg/hour
Methadone Dolophine 3.3 mg SC/IV; 0-15 mg PO 4 hours (first dose) 2.5-10 SC/PO
Morphine controlled release MS Contin, Oramorph 30 mg PO 8 hours 10-30 mg PO
Oxycodone controlled release Oxycontin 20 mg PO 12 hours 10 mg PO
Meperidine Demerol (not recommended except for prevention/treatment of rigors) 75 mg IV; 300 mg PO 2 hours 25-50 mg IV

Patient Controlled Analgesia (PCA)

Titrate to pain relief monitoring for side effects. Start with a lower dose and increase.

Morphine Sulfate

  • Standard concentration: 1 mg/mL
  • Loading dose: 2 mg; repeat PRN
  • Basal Rate: 0-2 mg/hour
  • PCA dose: 0.5-2 mg
  • Delay: 5-10 mins
  • Hour limit: 7.5-12.5 mg/hour

Hydromorphone (Dilaudid)

  • Standard concentration: 0.2 mg/mL
  • Loading dose: 0.4 mg; repeat PRN
  • Basal Rate: 0-0.2 mg/hour
  • PCA dose: 0.1-0.3 mg
  • Delay: 5-10 mins
  • Hour limit: 1.2-2.0 mg/hour

Fentanyl

  • Standard concentration: 10 mcg/mL
  • Loading dose: 25 mcg; repeat PRN
  • Basal Rate: 0-10 mcg/hour
  • PCA dose: 5-20 mcg
  • Delay: 4-8 mins
  • Hour limit: 75-125 mcg/hour

Prophylactic Antibiotic Administration

General Guidelines

Common Antibiotics

Drug Dose: < 120 kg; >120 kg Delivery Mode Redosing Interval (hrs)
Cefazolin 2 gm; 3 gm Bolus 3
Cefuroxime 1.5 gm; 2.25 gm Bolus 4
Cefoxitin 2 gm Bolus 2
Vancomycin 15 mg/kg Infusion (60-120 min) 12
Clindamycin 900 mg Infusion (10-60 min) 6
Ciprofloxacin 400 mg Infusion (60 min) 12
Levofloxacin 500 mg Infusion (60 min) 12
Metronidazole 0.5-1 gm Infusion (30-60 min) 12
Gentamicin 2.5-5 mg/kg Infusion (30-60 min) 12
Piperacillin-tazobactam 3.375 gm Infusion (10-60 min) 2
Ertapenem 1 g Infusion (10-60 min) 8-12

*Dosing will vary depending on the clinical situation/surgery performed – check hospital protocols and antibiotic resource guides prior to administration.

In general:

  • For surgeries requiring skin incisions
    • Cefazolin is the preferred agent (or vancomycin in cases with MRSA)
  • For GI surgeries (distal gut) and GU surgeries
    • Cefoxitin is the preferred agent
    • Cefazolin + Metronidazole for penicillin allergy
    • Clindamycin + Gentamicin or Clindamycin + Ciprofloxacin