Opioid analgesic supplement in general or regional anesth. For administration w/ a neuroleptic as anesth premed, induction & as an adjunct in the maintenance of general & regional anesth. As anesth agent in major surgery.
Individualized dosage. Analgesic supplement to general anesth Low dose: 2 mcg/kg. Moderate dose: 2-20 mcg/kg. High dose: 20-50 mcg/kg. Supplemental dose: 25-250 mcg until completion of the operation. Anesth agent 50-100 mcg/kg may be administered w/ O2 & muscle relaxant. May be increased up to 150 mcg/kg. Childn 2-12 yrInduction & maintenance 2-3 mcg/kg.
Discontinue if serotonin syndrome is suspected. Avoid rapid bolus inj in patients w/ compromised intracerebral compliance. Resp depression; muscle rigidity. May induce hypotension especially in hypovolemic patients & in higher incidence w/ neuroleptics. Patients on chronic opioid therapy or history of opioid abuse; w/ uncontrolled hypothyroidism, pulmonary disease, decreased resp reserve, alcoholism. Monitor for signs & symptoms of resp depression & profound sedation in concomitant use w/ CNS depressants. Concomitant use w/ serotonergic drugs eg, SSRIs & SNRIs & drugs which impair metabolism of serotonin (including MAOIs). Allow at least 24 hr after administration before driving or operating a machine. Impaired hepatic or renal function. Pregnancy. Breastfeeding is not recommended for 24 hr following administration. Elderly & debilitated patients.
May potentiate resp depression w/ CNS depressants eg, barbiturates, benzodiazepines or related drugs, neuroleptics, general anesth & alcohol. Clearance may be decreased w/ CYP3A4 inhibitor. Reduced clearance w/ oral ritonavir. Exposure may be increased &/or prolonged w/ other potent or less potent CYP3A4 inhibitors eg, voriconazole or fluconazole. Discontinue MAOIs 2 wk prior to any surgical or anesth procedure. May increase risk of serotonin syndrome w/ serotonergic agent eg, SSRI, SNRI or MAOI. Decreased total plasma clearance & vol of distribution of etomidate. Reduced plasma clearance of midazolam.
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