1. AL JADIDI SULAIMAN MODERATOR: DR TUAN NORIZAN 14/04/2011

6. MAC GRAY ZONE GENERAL ANESTHESIA Monitored Anesthesia Care

14. RESPONSIVENESS SPEECH FACIAL EXPRESSION EYES COMPOSITE SCORE LEVEL RESPOND READILY TO NAME SPOKEN IN NORMAL TONE NORMAL NORMAL CLEAR, NO PTOSIS 5 LETHARGIC RESPONSE TO NAME SPOKEN IN NORMAL TONE MILD SLOWING OR THICKENING MILD RELAXATION GLAZED OR PTOSIS (LESS THEN HALF THE EYE) 4 RESPOND ONLY AFTER NAME IS CALLED LOUDLY AND/OR REPEATEDLY SLURRING OR PROMINENT SLOWING MARKED RELAXATION GLAZED AND MARKED PTOSIS 3 RESPOND ONLY AFTER MILD PRODDING OR SHAKING FEW RECOGNISABLE WORDS 2 DOES NOT RESPOND TO MILD PRODDING OR SHAKING 1

28. PROPOFOL DEXMEDETOMIDINE Pain upon injection Yes Minimal Analgesic properties with subhypnotic dose Minimal Yes Amnestic properties with subhypnotic dose Significant Insignificant Type of onset with typical administration Rapid 5-10 minutes Use by anaest provider Yes No Potential for significant bradycardia Minimal significant

30. MIDAZOLAM DIAZEPAM Water soluble Lipid soluble Painless on injection Venoirritant Thrombophlebitis is rare Thrombophlebitis is common Short elimination half time (4 hours) Long elimination half time (> 20 hours) Clearance is unaffected by H2 antagonists Clearance is reduced by H2 antagonists Inactive metabolites (1-hydroxy midazolam) Active metabolites (desmethy-diazepam, oxazepam) Resedation is unlikely Resedation is more likely

39. DRUG TYPICAL ADULT IV DOSE (TITRATED TO EFFECT IN INCREAMENT0 BDZ Midazolam Diazepam 1-2mg before propofol or ramifentanil infusion 2.5-10mg OPIODS Alfentanil Fentanyl Ramifentanil 5-20mcg/kg bolus 2 minutes before stimulus 0.5-2mcg/kg bolus 2 minutes before stimulus 0.1mcg/kg/min infusion 5 minutes before stimulus then weaned to 0.05mcg/kg/min as tolerated (adjust increment up or down in 0.025mcg/kg/min Propofol 250-500 mcg/kg bolus, 25-75 mcg/kg/min infusion Ketamine 4-6 mg/kg PO, 2-4 mg/kg IM, 0.25-1mg/kg IV Dexmedetomidine 0.5-1.0mcg/kg over 10-20min followed by 0.2-0.7mcg/kg/h