Bone Biopsy Medication

Updated: Aug 31, 2016
  • Author: Krittika Teerapuncharoen, MD; Chief Editor: Dinesh Patel, MD, FACS  more...
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Medication

Antiseptics

Class Summary

These agents inhibit growth of gram-positive and gram-negative bacteria.

Chlorhexidine gluconate (PerioGard, Peridex, Hibiclens, Avagard)

Chlorhexidine binds to negatively charged bacterial cell walls and extramicrobial complexes. It has bacteriostatic and bactericidal effects.

Povidone-iodine ophthalmic solution 5% (Betadine)

Povidone-iodine is an antibacterial agent with broad antibacterial and antiviral activity. No bacteria are known to be resistant to it.

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Anxiolytics, Benzodiazepines

Class Summary

Administration of intravenous midazolam in the operating room can reduce anxiety, tachycardia, and hypertension.

Midazolam

Midazolam is a short-acting benzodiazepine with a rapid onset of action. It depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

Temazepam (Restoril)

Temazepam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

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Opioid Analgesics

Class Summary

Induction of anesthesia is accomplished by using high doses of opioid (usually fentanyl or alfentanil) to maximize cardiovascular stability.

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

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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Anesthetic Agents

Class Summary

After standard monitoring equipment is attached and peripheral venous access achieved but before the arterial line is inserted, the midazolam or lorazepam dose is administered.

Propofol (Diprivan)

Propofol is a phenolic compound unrelated to other types of anticonvulsants. It has general anesthetic properties when administered intravenously. Propofol IV produces rapid hypnosis, usually within 40 seconds. The effects are reversed within 30 minutes, following the discontinuation of infusion. Propofol has also been shown to have anticonvulsant properties.

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