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Drugs commonly used for monitored anesthesia care

Drugs commonly used for monitored anesthesia care
Medication Dose range* Onset Duration Comments
Midazolam 0.5 to 2 mg IV prior to propofol over 2 to 3 minutes; may repeat after 2 to 5 minutes 1 to 2.5 minutes 10 to 40 minutes
  • Potentiates the effects of other agents[1]
  • Sedative and anxiolytic
  • Prolonged effect or delayed recovery in older adults, obese, or impaired hepatic function
Propofol 250 to 500 mcg/kg IV bolus 30 seconds 5 to 10 minutes
  • Sedative and amnestic, no analgesia
  • Rapid recovery without residual
  • Pain on injection common
  • Respiratory depression and hypotension can occur
  • Reduce dose by 20% in older adults
25 to 75 mcg/kg/minute IV infusion 3 to 4 minutes, without bolus 4 minutes after discontinuation of infusion
Dexmedetomidine Loading: 0.5 to 1 mcg/kg over 10 to 20 minutes[2] 5 to 10 minutes 30 to 40 minutes[1]
  • Sedative, analgesic, without amnesia
  • Bradycardia and hypotension or hypertension may occur
Maintenance: 0.2 to 1 mcg/kg/hour
Ketamine 0.25 to 0.5 mg/kg IV 1 to 2 minutes 20 to 60 minutes
  • Dissociative sedative, amnestic, analgesic
  • Minimal cardiac or respiratory depression in small doses
  • Emergence reactions, nausea and vomiting possible
  • Prolonged effect in older adults
Opioids      
  • Analgesic, minimal sedation
  • Respiratory depression, nausea and vomiting may occur
Fentanyl 0.5 to 2 mcg/kg IV, administered in intermittent boluses of 25 to 50 mcg IV 2 to 3 minutes 30 to 60 minutes  
Remifentanil 0.1 mcg/kg/minute IV, started 5 minutes prior to stimulus; wean to 0.05 mcg/kg/minute IV as possible 1 to 1.5 minutes 3 to 5 minutes after discontinuation of infusion  
IV: intravenous
* Doses should be modified based on patient factors (eg, doses reduced for older adult patients) and when combinations of drugs are administered.
¶ Remifentanil dose should be reduced when administered with midazolam or propofol.
References:
  1. Dailymed: Midazolam (midazolam hydrochloride injection). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=737361a0-8db1-4d3c-ba5e-44df3f49fa22 (Accessed on October 20, 2016).
  2. Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95:461.
Data from:
  1. Gan TJ. Pharmacokinetic and pharmacodynamic characteristics of medications used for moderate sedation. Clin Pharmacokinet 2006; 45:855.
  2. Falk J, Zed P. Etomidate for procedural sedation in the emergency department. Ann Pharmacother 2004; 38:1272.
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