| Drug | Suggested dose | Advantages | Potential adverse effects |
| Opioids | - Fentanyl: 25 to 100 mcg (or 0.5 to 1 mcg/kg): may be administered in divided doses
- Sufentanil: 0.05 to 0.1 mcg/kg: may be administered in divided doses
(Reduce dose in older adults [≥70 years]; reduce or avoid dose in patients with hemodynamic instability.) | - Suppresses airway reflexes to prevent coughing and/or bronchospasm during laryngoscopy and intubation
- Attenuates stress response to prevent tachycardia and hypertension during laryngoscopy and intubation
- Minimizes pain caused by IV injection of induction agent
- Supplements sedation and reduces dose requirement of IV induction agent
| - Dose-dependent respiratory depression; possible apnea
- Pruritus
- Postoperative nausea and vomiting
|
| Lidocaine | - 0.5 to 1.5 mg/kg for suppression of airway reflexes (or 0.5 to 1 mg/kg in older adults [≥70 years])
- 20 to 30 mg total is used to reduce pain on injection of other agents
(Reduce or avoid dose in patients with hemodynamic instability.) | - Suppresses airway reflexes to prevent coughing during laryngoscopy and intubation
- Reduces airway responsiveness to noxious stimuli; reduces airway responsiveness to drugs that cause bronchospasm
- Minimizes pain caused by IV injection of induction agent
- Supplements sedation and reduces dose requirement of IV induction agent
| - Mild increases in airway tone
- Increases ventricular rate in patients with atrial fibrillation (avoid in patients with Wolff-Parkinson-White syndrome or high-grade heart block)
|
| Midazolam | - 1 to 2 mg is typical, administered in 1-mg increments
- Older adults (≥70 years): 0.5-mg increments up to 2 mg
(Reduce or avoid dose in patients with hemodynamic instability.) | - Reduces anxiety and produces amnesia; typically administered in the immediate preoperative period
- Supplements sedation and reduces dose requirement of IV induction agent
- Anticonvulsant
| - Mild systemic vasodilation and decreased cardiac output; may cause severe hypotension in hemodynamically unstable or hypovolemic patients
- Dose-dependent respiratory depression; possible apnea, particularly if coadministered with an opioid
|
