From the Guidelines
The order of unconsciousness cocktail typically involves administering a sedative, such as fentanyl, followed by a GABA receptor agonist sedative, like propofol, and then a neuromuscular blocking agent if necessary, to ensure patient comfort and airway control during intubation and mechanical ventilation. When considering the management of sedation and shivering after cardiac arrest, the most recent and highest quality study 1 suggests that fentanyl is often used as the first-line drug to achieve ventilator synchrony and suppress shivering, with propofol added as needed during the initial induction and maintenance phases. Some key points to consider when selecting medications for unconsciousness include:
- The use of opioid analgesics, such as fentanyl, as standard first-line drugs to provide analgesia and sedation for most patients receiving mechanical ventilation 1
- The addition of GABA receptor agonist sedatives, like propofol, when adequate sedation or suppression of shivering cannot be achieved with opioids alone 1
- The potential benefits and risks of alternative sedatives, such as ketamine and dexmedetomidine, which may have sedative, anti-shivering, and analgesic effects, but may not suppress respiratory drive during spontaneous ventilation 1
- The importance of pre-oxygenation before administering sedatives and neuromuscular blocking agents to maintain oxygen saturation during the procedure 1
- The need to consider the patient's condition, including hemodynamic stability, allergies, and underlying medical issues, when selecting medications for unconsciousness 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Order of Unconsciousness Cocktail
The order of unconsciousness cocktail, also known as the induction of anesthesia, typically involves a combination of medications to ensure a smooth and safe transition to unconsciousness. Based on the available evidence, the following medications are commonly used:
- Midazolam: a benzodiazepine used for sedation and anxiolysis 2, 3, 4
- Fentanyl: an opioid used for analgesia and sedation 2, 3, 5, 4
- Propofol: a hypnotic agent used for induction and maintenance of anesthesia 2, 3, 5
- Rocuronium: a neuromuscular blocking agent used to facilitate tracheal intubation 4
Typical Sequence of Administration
The typical sequence of administration for the unconsciousness cocktail is:
- Midazolam or propofol: administered first to induce sedation and anxiolysis
- Fentanyl: administered next to provide analgesia and sedation
- Rocuronium: administered last to facilitate tracheal intubation
Important Considerations
It is essential to note that the specific sequence and dosing of the medications may vary depending on the patient's condition, the procedure being performed, and the anesthesiologist's preference. Additionally, the use of these medications requires careful monitoring of the patient's vital signs and respiratory status to ensure safe and effective anesthesia 6, 4.