Fentanyl bolus 50 mcg IV every hour as needed for pain
Fentanyl IV infusion NSS
Propofol IV infusion
Lorazepam IV infusion
Lorazepam bolus 1mg IV every 2 hours as needed for agitation
Prevention of shivering is important to avoid warming and needless oxygen consumption
May require train of four monitor with goal of 1-2/4 twitches with neuromuscular blockade
Lower doses of NMB work against shivering
Higher doses of NMB used to paralyze the diaphragm in these scenarios:
Need to decrease O2 consumption
Decrease plateau pressures
Hypoxemia is present
Consider meperidine q2hrs:
50mg for normal renal function
25mg if CrCl < 30ml/min
Pancuronium IV infusion
Initiate before initiating cooling. Dosing recommendations: 0.1mg/kg loading dose followed by a continuous infusion of 0.33-2 mcg/kg/minute
Do not use in patients with renal and/or hepatic insufficiency
Cisatracurium for renal/hepatic impairment
0.2mg/kg IV bolus
Followed by infusion at 1 mcg/kg/min, max of 3 mcg/kg/min
Columbia University anti-shivering protocol
Need to decrease O2 consumption
Decrease plateau pressures
Hypoxemia is present
50mg for normal renal function
25mg if CrCl < 30ml/min
Initiate before initiating cooling. Dosing recommendations: 0.1mg/kg loading dose followed by a continuous infusion of 0.33-2 mcg/kg/minute
Do not use in patients with renal and/or hepatic insufficiency
0.2mg/kg IV bolus
Followed by infusion at 1 mcg/kg/min, max of 3 mcg/kg/min
Therapeutic hypothermia
Ventriculoperitoneal shunt drainage
ICU sedation
Extracorporeal membrane oxygenation
Traumatic asphyxia
Ventriculoperitoneal shunt obstruction
Advanced airway adjuncts
Neonatal resuscitation