Perioperative Medications Cheat Sheet
Review these essential medication classes, anesthesia agents, and safety rules. Pin or print this quick-reference guide to memorize key effects and red flags.
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Inhalation Anesthetics (Volatile Agents)
Isoflurane / Sevoflurane / Desflurane — volatile liquids, potent triggers for malignant hyperthermia (MH). Nitrous Oxide — weak anesthetic but strong analgesic, expands in closed air spaces (avoid in bowel obstruction, pneumothorax, or middle ear surgery). Halothane — rarely used in modern practice, carries high risk of hepatotoxicity and MH.
Intravenous Induction Agents
Propofol — rapid onset and recovery, causes hypotension and respiratory depression, requires strict aseptic technique (lipid emulsion supports bacterial growth). Etomidate — minimal cardiovascular depression, ideal for hemodynamically unstable patients, can cause myoclonus and adrenal suppression. Ketamine — dissociative anesthesia, provides analgesia, increases heart rate and blood pressure, carries risk of emergence delirium. Dexmedetomidine — alpha-2 agonist, provides sedation and analgesia without significant respiratory depression, monitor for bradycardia.
Neuromuscular Blocking Agents (NMBAs)
Succinylcholine — depolarizing agent, rapid onset, triggers malignant hyperthermia, causes transient hyperkalemia (contraindicated in severe burns or crush injuries). Rocuronium / Vecuronium — non-depolarizing agents, reversed by neostigmine or sugammadex, no MH risk. Cisatracurium — non-depolarizing agent, undergoes Hofmann elimination (organ-independent clearance), ideal for patients with renal or hepatic impairment.
Reversal Agents
Naloxone — reverses opioid-induced respiratory depression, short half-life requires close monitoring for re-sedation. Flumazenil — reverses benzodiazepines, carries risk of seizures in chronic benzodiazepine users. Neostigmine — reverses non-depolarizing NMBAs, must be administered with an anticholinergic (glycopyrrolate or atropine) to prevent severe bradycardia. Sugammadex — selectively encapsulates and reverses rocuronium and vecuronium, renders hormonal contraceptives ineffective for seven days.
Local Anesthetics
Lidocaine / Bupivacaine / Ropivacaine — block nerve conduction, always monitor for Local Anesthetic Systemic Toxicity (LAST). Epinephrine additive — prolongs anesthetic block duration and decreases systemic absorption, avoid in end-artery areas (fingers, toes, nose, penis). LAST symptoms — perioral numbness, metallic taste, tinnitus, agitation, seizures, progressing to cardiovascular collapse. LAST treatment — immediately stop injection, secure the airway, and administer 20% lipid emulsion therapy.
Analgesics & Adjuncts
Fentanyl / Sufentanil — synthetic opioids, rapid onset, cause respiratory depression and chest wall rigidity if pushed too rapidly. Midazolam — short-acting benzodiazepine, provides amnesia and anxiolysis, monitor for respiratory depression. Ondansetron — serotonin antagonist, prevents postoperative nausea and vomiting (PONV), can prolong the QT interval. Dexamethasone — corticosteroid, used as an antiemetic and anti-inflammatory adjunct, may increase postoperative blood glucose levels.
High-Alert Perioperative Medications
Heparin — anticoagulant used in vascular procedures, reversed by protamine sulfate, monitor Activated Clotting Time (ACT). Protamine Sulfate — heparin reversal agent, carries risk of severe hypotension and anaphylaxis (higher risk in patients with fish allergies or prior vasectomy). Dantrolene — direct-acting muscle relaxant, the only specific treatment for malignant hyperthermia, requires rapid reconstitution with sterile water. Tranexamic Acid (TXA) — antifibrinolytic, prevents clot breakdown to reduce surgical bleeding, monitor for thromboembolic events.
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