Medication Summary

The goals of pharmacotherapy are to sedate and reduce morbidity.

Class Summary

In the operating room, intravenous (IV) administration of a small dose of midazolam before arterial line insertion can reduce anxiety, tachycardia, and hypertension.

Midazolam

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Midazolam is a short-acting benzodiazepine with a rapid onset of action.

Class Summary

Induction of anesthesia is accomplished by using high doses of an opioid (usually fentanyl or remifentanil).

Fentanyl citrate (Duragesic, Abstral, Actiq, Fentora, Onsolis)

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Fentanyl citrate is a synthetic opioid that has 75-200 times more potency and a much shorter half-life than morphine sulfate. It has fewer hypotensive effects than morphine and is safer in patients with hyperactive airway disease because of minimal or no associated histamine release. By itself, fentanyl citrate causes little cardiovascular compromise, although the addition of benzodiazepines or other sedatives may result in decreased cardiac output and blood pressure.

Fentanyl citrate is highly lipophilic and protein-bound. Prolonged exposure to it leads to accumulation of the drug in fat and delays the weaning process. Consider continuous infusion because of the medication's short half-life.

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