# Clinical Sources for Helix Anesthesia

Every dose, max, and protocol in Helix Anesthesia mapped to its primary reference. This document maps each clinical value in the app to a verifiable external source (FDA package insert, society guideline, or primary literature) so any clinician can verify our work.

> **Review status — pending external peer review.**
> The doses and protocols below were compiled and cross-referenced against the cited sources by the development team. Independent clinical peer review by anesthesia clinicians is in progress. Reviewers who have signed off are listed in the **Reviewer Audit Log** at the bottom of this document. Until that log shows a reviewer signature for a given section, treat that section as developer-cited but not externally peer-reviewed.

**Disclaimer**: Doses verified to the best of authors' knowledge against the cited references at the time of authoring. Drug labels change; verify each dose against the most current package insert before clinical use. Helix Anesthesia is a reference tool and does not replace clinical judgment.

---

## How to find any cited source

**FDA package inserts** — All major drug PIs are searchable at the FDA's DailyMed:
- https://dailymed.nlm.nih.gov/dailymed/index.cfm
- Direct PDFs hosted at accessdata.fda.gov are linked inline below.

**Journal articles** — Every cited article can be located on PubMed by entering the citation (author + year + journal):
- PubMed search: https://pubmed.ncbi.nlm.nih.gov/
- Free abstracts for every cited article; full text may require institutional access via your hospital library.
- Many articles are also open-access on PubMed Central (PMC).

**Society guidelines** — Direct URLs to society documents are listed inline (AHA, ASA, ASRA, ACOG, SMFM, MHAUS, NCCMERP).

**Textbook references** — Edition-dependent page numbers. Chapter titles are the stable reference. Publisher URLs for textbooks:
- **Miller's Anesthesia, 10th ed** (Gropper, Cohen, Eriksson, Fleisher, Leslie, Johnson-Akeju; Elsevier 2024; ISBN 9780323935920): https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0 · Also on ClinicalKey
- **A Practice of Anesthesia for Infants and Children, 6th ed** (Coté, Lerman, Anderson; Elsevier 2018; ISBN 9780323429740): https://shop.elsevier.com/books/a-practice-of-anesthesia-for-infants-and-children/cote/978-0-323-42974-0
- **Stoelting's Pharmacology & Physiology in Anesthetic Practice, 6th ed** (Flood, Rathmell, Urman; LWW 2022; ISBN 9781975126896): https://shop.lww.com/Stoelting-s-Pharmacology---Physiology-in-Anesthetic-Practice/p/9781975126896
- **Cousins and Bridenbaugh's Neural Blockade, 4th ed** (Cousins, Carr, Horlocker, Bridenbaugh; LWW 2009): https://www.wolterskluwer.com/en/solutions/ovid/cousins-and-bridenbaughs-neural-blockade-in-clinical-anesthesia-and-pain-medicine-5380
- **Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th ed** (Cullen, Stock, Ortega; LWW 2023; ISBN 9781975199074): https://shop.lww.com/Barash--Cullen--and-Stoelting-s-Clinical-Anesthesia--Print---eBook-with-Multimedia/p/9781975199074

---

## 1. Local Anesthetics — Maximum Doses

The figures below are **absolute single-dose ceilings** intended for LAST (local anesthetic systemic toxicity) calculation — i.e., the maximum a patient should receive in one administration regardless of technique (infiltration, peripheral block, epidural). Where the FDA label gives an explicit mg/kg, that is quoted directly. Where the FDA label only gives an absolute mg cap (bupivacaine, mepivacaine adult, ropivacaine), the mg/kg figure is the standard textbook back-calculation used across Miller's, Stoelting's, and Barash. Infiltration-only tables in some textbooks (e.g. Miller's 8e Table 36-4) quote more conservative numbers for that specific use — those are not wrong, but they are narrower than the toxicity-ceiling values below.

| Agent | Plain (mg/kg) | Plain cap (mg) | With epi (mg/kg) | Epi cap (mg) | Source |
|---|---|---|---|---|---|
| Lidocaine | 4.5 | 300 | 7 | 500 | Xylocaine PI; Miller's 10e Ch. 47 |
| Mepivacaine | 5 | 400 | 7 | 500 | Carbocaine PI (adult absolute cap); Miller's 10e |
| Bupivacaine | **2.5** | **175** | 3 | 225 | Marcaine PI (FDA: "single doses up to 175 mg plain, 225 mg with epi"); Miller's 10e; ASRA |
| Ropivacaine | 3 | 225 | — | — | Naropin PI (cumulative 770 mg/24h); single-dose mg/kg per Miller's 10e / Stoelting's. *With-epi ceiling not listed: ropivacaine has intrinsic vasoconstrictor properties and the FDA Naropin label does not endorse epinephrine co-administration; clinicians using ropi + epi off-label should reference a more specialized source.* |
| Chloroprocaine | 11 | 800 | 14 | 1000 | Nesacaine PI |
| Procaine | 7 | 500 | 9 | 600 | Novocain PI |
| Prilocaine | 6 | 400 | 8 | 600 | Citanest PI (dental, FDA-approved US form). Plain mg/kg per anesthesia-text convention reflecting methemoglobinemia risk |
| Tetracaine | 1 | 100 | — | — | Pontocaine PI. Modern use is spinal (5-20 mg total) and topical, not infiltration |

**Primary URLs:**
- Marcaine (bupivacaine HCl) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=bupivacaine)
- Xylocaine (lidocaine HCl) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine)
- Naropin (ropivacaine) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ropivacaine)
- Nesacaine (chloroprocaine) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=chloroprocaine)
- Carbocaine (mepivacaine) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=mepivacaine)
- Novocaine (procaine) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=procaine)
- Citanest (prilocaine) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=prilocaine)
- Pontocaine (tetracaine) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=tetracaine)
- Miller's Anesthesia 10e Ch. 47 "Local Anesthetics" — [Elsevier](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0)
- ASRA LAST Checklist (max-dose guidance) — [ASRA](https://www.asra.com/guidelines-articles)

---

## 2. Sugammadex (Reversal)
| Indication | Dose | Source |
|---|---|---|
| TOF count ≥ 2 (shallow/moderate block) | 2 mg/kg | Bridion PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sugammadex) · [FDA label PDF](https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022225lbl.pdf) |
| 1-2 PTC, no TOF (deep block) | 4 mg/kg | Bridion PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sugammadex) |
| Immediate reversal of profound block, within 3 min of 1.2 mg/kg rocuronium | 16 mg/kg | Bridion PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sugammadex) |

**URLs:**
- Bridion (sugammadex) PI — [DailyMed search](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sugammadex) · [FDA 2015 label PDF](https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022225lbl.pdf)
- FDA approval letter — [FDA NDA 022225](https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/022225Orig1s000Approv.pdf)

**Caveats noted in app:**
- Hormonal contraceptive interaction (PI Section 7.1)
- CrCl <30 mL/min not recommended (PI Section 8.6)
- Bradycardia rare but reported (PI Section 5.2)

---

## 3. Sugammadex — Pediatric

| Dose | Source |
|---|---|
| 2 mg/kg (TOF ≥ 2) | Bridion PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sugammadex) |
| 4 mg/kg (deep block) | Bridion PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sugammadex) |
| 16 mg/kg (immediate) | Bridion PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sugammadex) |

Pediatric dosing extrapolated from adult PI per Bridion label (approved age ≥ 2 years by FDA 2021) — [DailyMed Bridion label](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sugammadex).

---

## 4. Neuraxial / Intrathecal Adjuvants —  (`NEURAXIAL_ADJUVANTS`)

| Drug | Dose (intrathecal, total) | Source |
|---|---|---|
| Fentanyl | 10–25 mcg | Miller's 10e Ch. 56 "Spinal Anesthesia" — [Miller's product page](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0); Sublimaze PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=fentanyl) |
| Sufentanil | 2.5–10 mcg | Miller's 10e Ch. 56 — [Miller's](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0); Sufenta PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sufentanil) |
| Morphine (preservative-free) | 100–200 mcg | Duramorph PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=duramorph); Carvalho B, et al. *Anesth Analg* 2005;100:1150-1158 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/15781537/) |
| Epinephrine | 100–200 mcg | Miller's 10e Ch. 56 — [Miller's](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0); Adrenalin PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=epinephrine) |
| Clonidine | 15–75 mcg total | Catapres PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=clonidine); Stoelting's Pharmacology, 6th ed — [LWW](https://shop.lww.com/Stoelting-s-Pharmacology---Physiology-in-Anesthetic-Practice/p/9781975126896) |
| Dexmedetomidine | 3–10 mcg total (off-label) | Kanazi GE, et al. *Acta Anaesthesiol Scand* 2006;50:222-227 (3 mcg dose) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/16430546/); Al-Mustafa MM, et al. *Saudi Med J* 2009;30:365-370 (5-10 mcg dose) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/19271064/) |

**Epidural adjuvants:**
| Drug | Dose | Source |
|---|---|---|
| Fentanyl bolus | 50–100 mcg | Stoelting's Pharmacology — [LWW](https://shop.lww.com/Stoelting-s-Pharmacology---Physiology-in-Anesthetic-Practice/p/9781975126896); Cousins & Bridenbaugh 4e — [Wolters Kluwer](https://www.wolterskluwer.com/en/solutions/ovid/cousins-and-bridenbaughs-neural-blockade-in-clinical-anesthesia-and-pain-medicine-5380); Sublimaze PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=fentanyl) |
| Morphine epidural | 1–4 mg | Duramorph PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=duramorph) |
| Epinephrine test dose | 15 mcg with 3 mL 1.5% lidocaine | Moore DC, Batra MS. *Anesthesiology* 1981;55:693-696 — [ASA Pubs](https://pubs.asahq.org/anesthesiology/article/55/6/693/29823) |

---

## 5. Peripheral Block Adjuvants —  (`BLOCK_ADJUVANTS`)

| Drug | Dose (perineural) | Source |
|---|---|---|
| Epinephrine | 1:200,000–400,000 (2.5–5 mcg/mL) | Miller's 10e Ch. 57 — [Miller's](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0); Adrenalin PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=epinephrine) |
| Dexamethasone | 4–8 mg perineural | Choi S, et al. *Br J Anaesth* 2014;112:427-439 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/24413428/) |
| Clonidine | 0.5–1 mcg/kg (max 75–150 mcg) | Pöpping DM, et al. *Anesthesiology* 2009;111:406-415 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/19602964/) |
| Sodium bicarbonate | 1 mEq per 10 mL lidocaine | Hilgier M. *Reg Anesth* 1985;10:59-61 (older paper, not indexed in PubMed; see Sources Without a Confirmed Direct URL section for alternative refs) |
| Buprenorphine | 150–300 mcg perineural | Candido KD, et al. *Reg Anesth Pain Med* 2002;27:162-167 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/11915063/) |
| Dexmedetomidine | 0.5–1 mcg/kg perineural | Abdallah FW, Brull R. *Br J Anaesth* 2013;110:915-925 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/23587874/) |

---

## 6. Spinal Anesthesia Dose by Procedure
| Procedure | Bupivacaine dose | Source |
|---|---|---|
| Lower extremity / saddle (T10-L1) | 10–15 mg | Cousins & Bridenbaugh 4e — [Wolters Kluwer](https://www.wolterskluwer.com/en/solutions/ovid/cousins-and-bridenbaughs-neural-blockade-in-clinical-anesthesia-and-pain-medicine-5380); Miller's 10e Ch. 56 — [Miller's](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0) |
| C-section (T4) | 10–12 mg hyperbaric | ACOG Practice Bulletin 209 (Obstetric Analgesia/Anesthesia) — [ACOG](https://www.acog.org/clinical/clinical-guidance/practice-bulletin); SOAP Centers of Excellence — [SOAP](https://www.soap.org/) |
| Lower abdomen / inguinal hernia (T6-T8) | 11–15 mg | Cousins & Bridenbaugh 4e — [Wolters Kluwer](https://www.wolterskluwer.com/en/solutions/ovid/cousins-and-bridenbaughs-neural-blockade-in-clinical-anesthesia-and-pain-medicine-5380) |
| Saddle block (S2-S5) | 5–7 mg, patient sits × 5 min | Cousins & Bridenbaugh 4e — [Wolters Kluwer](https://www.wolterskluwer.com/en/solutions/ovid/cousins-and-bridenbaughs-neural-blockade-in-clinical-anesthesia-and-pain-medicine-5380) |

Alternative LAs (Spinal screen):
- Ropivacaine 0.5–0.75%: 12–20 mg (Naropin PI off-label spinal use) — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ropivacaine)
- Mepivacaine 1.5–2% isobaric: 40–60 mg — Dose-response study: Zayas VM, et al. *Anesth Analg* 1999;89:1167-1171 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/10553828/)
- 2-Chloroprocaine 3% PF: 30–50 mg — Goldblum E, Atchabahian A. *Acta Anaesthesiol Scand* 2013 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/23320599/); Nesacaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=chloroprocaine)
- Lidocaine 5% hyperbaric: 60–100 mg (⚠ TNS rate 10-30% — Pollock JE. *Anesth Analg* 2003) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/12873924/); Xylocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine)
- Tetracaine 0.5–1%: 6–12 mg — Pontocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=tetracaine)

---

## 7. Sevoflurane / Volatile Anesthetics —  (MAC values)

MAC values per age group from:
- Stevens WC, et al. *Anesthesiology* 1975;42:197-200 (original MAC isoflurane study; commonly referenced for sevoflurane via comparator data) — [ASA Pubs](https://pubs.asahq.org/anesthesiology/article/42/2/197/26839)
- Mapleson WW. *Br J Anaesth* 1996;76:179-185 (age-adjustment formula for MAC) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/8777094/)
- Ultane (sevoflurane) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sevoflurane) · [FDA 2006 label PDF](https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/020478s016lbl.pdf)
- Forane (isoflurane) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=isoflurane)
- Suprane (desflurane) PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=desflurane)

---

## 8. Pediatric Doses —  (`pediatricDoseGroups`)

### Emergency / Code

Primary reference for this entire section: **AHA PALS 2020** — Topjian AA, et al. *Circulation* 2020;142:S469-S523 — [AHA Journals](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901) · [PubMed](https://pubmed.ncbi.nlm.nih.gov/33081526/) · ECC guidelines portal: [cpr.heart.org](https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines).

| Drug | Dose | Source |
|---|---|---|
| Epinephrine 1:10,000 IV/IO | 0.01 mg/kg (max 1 mg) | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Adrenalin PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=epinephrine) |
| Epinephrine 1:1,000 IM (anaphylaxis) | 0.01 mg/kg (max 0.5 mg) | Sicherer SH, Simons FER. *Pediatrics* 2017;139:e20164006 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/28193791/); AAAAI Anaphylaxis Practice Parameter — [AAAAI](https://www.aaaai.org/practice-resources/statements-and-practice-parameters) |
| Atropine | 0.02 mg/kg (min 0.1 mg, max 0.5 mg) | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Atropine sulfate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=atropine) |
| Amiodarone | 5 mg/kg, max 300 mg | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Cordarone IV PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=amiodarone) |
| Lidocaine | 1 mg/kg | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Xylocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine) |
| Adenosine (1st) | 0.1 mg/kg (max 6 mg); (2nd) 0.2 mg/kg (max 12 mg) | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Adenocard PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=adenosine) |
| Calcium chloride 10% | 20 mg/kg (max 1 g) | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Calcium chloride PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=calcium+chloride) |
| Calcium gluconate 10% | 60 mg/kg (max 3 g) | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Calcium gluconate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=calcium+gluconate) |
| Sodium bicarbonate | 1 mEq/kg | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Sodium bicarbonate inj PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sodium+bicarbonate) |
| Magnesium sulfate | 25–50 mg/kg (max 2 g) | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); Magnesium sulfate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=magnesium+sulfate) |
| Naloxone (emergency) | 0.01 mg/kg (max 2 mg) | Naloxone PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=naloxone) |
| Flumazenil | 0.01 mg/kg (max 0.2 mg per dose) | Romazicon PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=flumazenil) |
| Defibrillation | 2 J/kg → 4 J/kg → up to 10 J/kg | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901) |
| Cardioversion (sync) | 0.5–1 J/kg → 2 J/kg | AHA PALS 2020 — [AHA](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901) |

### Premedication

| Drug | Dose | Source |
|---|---|---|
| Midazolam PO | 0.5 mg/kg (max 20 mg) | Versed PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=midazolam); Coté 6e — [Elsevier](https://shop.elsevier.com/books/a-practice-of-anesthesia-for-infants-and-children/cote/978-0-323-42974-0) |
| Midazolam IN | 0.2 mg/kg (max 10 mg) | Karl HW, et al. *Anesthesiology* 1992;76:209-215 — [ASA Pubs](https://pubs.asahq.org/anesthesiology/article/76/2/209/30801) |
| Midazolam IV | 0.05 mg/kg (max 5 mg) | Versed PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=midazolam) |
| Ketamine PO | 6 mg/kg (max 300 mg) | Ketalar PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ketamine); Sekerci C, et al. *Br J Anaesth* 1996;76:28-33 — [PubMed search](https://pubmed.ncbi.nlm.nih.gov/?term=Sekerci+ketamine+1996) |
| Ketamine IM | 4 mg/kg | Ketalar PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ketamine) |
| Dexmedetomidine IN | 1–2 mcg/kg | Yuen VM. *Anesth Analg* 2007;105:374-380 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/17646493/); Precedex PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dexmedetomidine) |
| Clonidine PO | 4 mcg/kg | Mikawa K, et al. *Anesthesiology* 1996;85:954-960 — [ASA Pubs](https://pubs.asahq.org/anesthesiology/article/85/5/954/35728); Catapres PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=clonidine) |

### Induction Agents

| Drug | Dose | Source |
|---|---|---|
| Propofol | 2–3 mg/kg | Diprivan PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=propofol); Coté 6e Ch. 9 — [Elsevier](https://shop.elsevier.com/books/a-practice-of-anesthesia-for-infants-and-children/cote/978-0-323-42974-0) |
| Ketamine IV | 1–2 mg/kg | Ketalar PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ketamine) |
| Etomidate | 0.3 mg/kg | Amidate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=etomidate) |
| Thiopental | 4–6 mg/kg | Pentothal PI (historical, US supply discontinued 2011) — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=thiopental); Coté 6e Ch. 9 — [Elsevier](https://shop.elsevier.com/books/a-practice-of-anesthesia-for-infants-and-children/cote/978-0-323-42974-0) |
| Sevoflurane mask | 8% in 50/50 N2O/O2 | Ultane PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sevoflurane); Lerman J, et al. *Anesthesiology* 1994;80:814-824 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/8024136/) |

### Paralytics & Reversal

| Drug | Dose | Source |
|---|---|---|
| Succinylcholine IV | 2 mg/kg (infants), 1–1.5 mg/kg (children) | Anectine PI — [FDA label](https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/008453s027lbl.pdf) · [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=succinylcholine); Cook DR, et al. *Anesth Analg* 1981 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/7194001/) |
| Succinylcholine IM | 4 mg/kg | Anectine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=succinylcholine); Liu LM, et al. *Anesthesiology* 1981 — [PubMed search](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+succinylcholine+IM+1981) |
| Rocuronium (intubation) | 0.6 mg/kg | Zemuron PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=rocuronium) |
| Rocuronium (RSI) | 1.2 mg/kg | Mazurek AJ, et al. *Anesth Analg* 1998;87:1259-1262 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/9842809/); Zemuron PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=rocuronium) |
| Vecuronium | 0.1 mg/kg | Norcuron PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=vecuronium) |
| Cisatracurium | 0.15 mg/kg | Nimbex PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=cisatracurium) |
| Neostigmine | 0.05 mg/kg (max 5 mg) | Bloxiverz PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=neostigmine) |

### Analgesia & Opioid Reversal

| Drug | Dose | Source |
|---|---|---|
| Fentanyl | 1–2 mcg/kg | Sublimaze PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=fentanyl); Coté 6e Ch. 9 — [Elsevier](https://shop.elsevier.com/books/a-practice-of-anesthesia-for-infants-and-children/cote/978-0-323-42974-0) |
| Morphine | 0.05–0.1 mg/kg | Morphine sulfate inj PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=morphine+sulfate+injection) |
| Hydromorphone | 10–15 mcg/kg | Dilaudid PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=hydromorphone) |
| Remifentanil | 0.05–0.2 mcg/kg/min infusion | Ultiva PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=remifentanil) |
| Ketorolac (Toradol) | 0.5 mg/kg IV, max 30 mg/dose | Toradol PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ketorolac) |
| Acetaminophen IV | 15 mg/kg, max 1 g/dose, max 75 mg/kg/day (children), 60 mg/kg/day (infants) | Ofirmev PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ofirmev) |
| Acetaminophen PR | Load 40 mg/kg PR, then 20 mg/kg q6h | Birmingham PK, et al. *Anesthesiology* 1997 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/9286887/) |
| Naloxone (postop reversal) | 1–5 mcg/kg titrated | Naloxone PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=naloxone) |
| Flumazenil | 0.01 mg/kg, max 0.2 mg | Romazicon PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=flumazenil) |

### Antiemetics

| Drug | Dose | Source |
|---|---|---|
| Ondansetron | 0.1 mg/kg (max 4 mg) | Zofran PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ondansetron) |
| Dexamethasone | 0.1–0.15 mg/kg (max 10 mg) | Decadron PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dexamethasone); Henzi I, et al. *Anesth Analg* 2000 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/10625002/) |
| Metoclopramide (Reglan) | 0.15 mg/kg (max 10 mg) | Reglan PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=metoclopramide) |
| Famotidine | 0.25 mg/kg (max 20 mg) | Pepcid PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=famotidine) |
| Ranitidine (Zantac) | 1 mg/kg (max 50 mg) — IV; oral pulled 2020 (NDMA) | FDA recall — [fda.gov](https://www.fda.gov/news-events/press-announcements/fda-requests-removal-all-ranitidine-products-zantac-market) |
| Promethazine (Phenergan) | 0.25 mg/kg, max 12.5 mg — **CONTRAINDICATED < 2 yrs** | Phenergan PI (FDA black box) — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=promethazine) |
| Diphenhydramine | 0.5–1 mg/kg (max 50 mg) | Benadryl PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=diphenhydramine) |

### Cardiovascular

| Drug | Dose | Source |
|---|---|---|
| Ephedrine | 0.1–0.3 mg/kg IV | Ephedrine sulfate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ephedrine); Stoelting's Pharmacology 6e — [LWW](https://shop.lww.com/Stoelting-s-Pharmacology---Physiology-in-Anesthetic-Practice/p/9781975126896) |
| Phenylephrine | 1–5 mcg/kg IV | Neo-Synephrine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=phenylephrine) |
| Glycopyrrolate | 0.005 mg/kg (max 0.2 mg) | Robinul PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=glycopyrrolate) |
| Esmolol | 0.5 mg/kg bolus; 50–200 mcg/kg/min infusion | Brevibloc PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=esmolol) |
| Labetalol | 0.2–1 mg/kg IV (max 20 mg/dose) | Trandate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=labetalol) |
| Hydralazine | 0.1–0.2 mg/kg IV (max 20 mg) | Apresoline / Hydralazine HCl PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=hydralazine) |
| Nitroglycerin | 1–5 mcg/kg/min infusion | Nitroglycerin injection PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=nitroglycerin) |
| Nicardipine | 0.5–3 mcg/kg/min infusion | Cardene IV PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=nicardipine) |

### Local Anesthetics (Pediatric)

| Drug | Dose | Source |
|---|---|---|
| Bupivacaine 0.25% (caudal) | 1 mL/kg sacral, 1.25 mL/kg high-lumbar (max 2 mg/kg) | Coté 6e Ch. 17 — [Elsevier](https://shop.elsevier.com/books/a-practice-of-anesthesia-for-infants-and-children/cote/978-0-323-42974-0); Brown TC, et al. *Anaesth Intensive Care* 1986 — [PubMed search](https://pubmed.ncbi.nlm.nih.gov/?term=Brown+caudal+bupivacaine+1986) |
| Bupivacaine plain max | 2.5 mg/kg, abs cap 175 mg | Marcaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=bupivacaine) |
| Ropivacaine 0.2% (caudal) | 1 mL/kg | Naropin PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ropivacaine); Bösenberg AT, et al. *Acta Anaesthesiol Scand* 2001;45:1276-1280 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/11736682/) |
| Lidocaine plain | 4.5 mg/kg | Xylocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine) |
| Lidocaine with epi | 7 mg/kg | Xylocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine) |
| Spinal bupivacaine 0.5% (infant) | 0.4–0.6 mg/kg | Williams RK, et al. *Anesth Analg* 2006;102:67-71 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/16368805/) |

### Smooth Emergence

| Drug | Dose | Source |
|---|---|---|
| Lidocaine IV | 1–1.5 mg/kg ~2 min pre-extubation | Yukioka H, et al. *Anesth Analg* 1985 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/4061901/); Xylocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine) |
| Propofol (sub-induction) | 0.5–1 mg/kg slow IV | Ouellet MF, et al. *Can J Anaesth* 2023;70:842-850 (propofol bolus for cough at emergence, RCT) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/36829104/); Diprivan PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=propofol) |
| Dexmedetomidine (bolus) | 0.3–0.5 mcg/kg | Precedex PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dexmedetomidine); Bhana N, et al. *Drugs* 2000 — [PubMed search](https://pubmed.ncbi.nlm.nih.gov/?term=Bhana+dexmedetomidine+Drugs+2000) |
| Fentanyl (small dose) | 0.5–1 mcg/kg ~5 min pre-extubation | Sublimaze PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=fentanyl) |

### MH — Dantrolene

| Drug | Dose | Source |
|---|---|---|
| Dantrolene initial | 2.5 mg/kg IV | MHAUS 2024 guidelines: https://www.mhaus.org/healthcare-professionals/managing-a-crisis/; Ryanodex PI: https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ryanodex |
| Dantrolene maintenance | 1 mg/kg q4-6h × 24-48 h | MHAUS 2024 |

---

## 9. Apfel PONV Score
**Primary:** Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. *A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers.* Anesthesiology 1999;91:693-700.
- [PubMed](https://pubmed.ncbi.nlm.nih.gov/10485781/)

**Antiemetic doses cited in app:**
- Ondansetron 4 mg IV — Zofran PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ondansetron)
- Dexamethasone 4-8 mg IV — Apfel CC, et al. *NEJM* 2004;350:2441-2451 (IMPACT trial) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/15190136/); Decadron PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dexamethasone)
- Droperidol 0.625-1.25 mg IV — Inapsine PI (FDA black box QT — monitor) — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=droperidol)
- Aprepitant 40 mg PO — Emend PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=aprepitant)
- Scopolamine 1.5 mg transdermal — Transderm Scop PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=scopolamine)

---

## 10. RCRI (Lee) + Gupta MICA
**RCRI:** Lee TH, Marcantonio ER, Mangione CM, et al. *Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.* Circulation 1999;100:1043-1049.
- URL: https://www.ahajournals.org/doi/10.1161/01.CIR.100.10.1043

**Gupta MICA:** Gupta PK, Gupta H, Sundaram A, et al. *Development and validation of a risk calculator for prediction of cardiac risk after surgery.* Circulation 2011;124:381-387.
- URL: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.110.015701
- NSQIP risk calculator (live tool): https://riskcalculator.facs.org/

The Gupta MICA coefficients used in the app are from the supplement of the Gupta 2011 *Circulation* paper.

---

## 11. STOP-BANG
**Primary:** Chung F, Yegneswaran B, Liao P, et al. *STOP questionnaire: a tool to screen patients for obstructive sleep apnea.* Anesthesiology 2008;108:812-821.
- URL (PubMed): https://pubmed.ncbi.nlm.nih.gov/18431116/
- STOP-Bang official site (additional content): http://www.stopbang.ca/

---

## 12. NPO Fasting Guidelines
**Primary:** ASA Task Force on Preoperative Fasting. *Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report.* Anesthesiology 2017;126:376-393.
- URL: https://pubs.asahq.org/anesthesiology/article/126/3/376/19733/
- ASA Clear Liquids Update 2023 (extends to 2 hr): https://www.asahq.org/standards-and-practice-parameters

---

## 13. ASRA Anticoagulation
**Primary:** Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. *Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: ASRA Evidence-Based Guidelines (Fourth Edition).* Reg Anesth Pain Med 2018;43:263-309.
- URL: https://rapm.bmj.com/content/43/3/263

---

## 14. Crisis Checklists —  (`crisisData`)

| Crisis | Source |
|---|---|
| Malignant Hyperthermia | MHAUS Emergency Protocol — [MHAUS](https://www.mhaus.org/healthcare-professionals/managing-a-crisis/); Dantrolene PI (Ryanodex) — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ryanodex) |
| LAST | ASRA 2020 Checklist for Treatment of Local Anesthetic Systemic Toxicity — [ASRA Guidelines](https://www.asra.com/guidelines-articles); Neal JM, et al. *Reg Anesth Pain Med* 2018;43:113-123 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/29356773/) |
| CICO | Difficult Airway Society 2015 Intubation Guidelines — [DAS](https://das.uk.com/guidelines/das_intubation_guidelines); ASA 2022 Difficult Airway Guidelines — [ASA Pubs](https://pubs.asahq.org/anesthesiology/article/136/1/31/117507) |
| Anaphylaxis | Shaker MS, et al. AAAAI/ACAAI 2020 Anaphylaxis Practice Parameter Update. *J Allergy Clin Immunol* 2020;145:1082-1123 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/32001253/); AAAAI guidance portal — [AAAAI](https://www.aaaai.org/practice-resources/statements-and-practice-parameters) |
| ACLS | AHA 2020 ECC Guidelines — [cpr.heart.org](https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines); Panchal AR, et al. *Circulation* 2020;142:S366-S468 — [AHA Journals](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000916) · [PubMed](https://pubmed.ncbi.nlm.nih.gov/33081529/) |
| PALS | AHA PALS 2020 — [AHA Journals](https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901); see Section 8 above |
| Massive Transfusion Protocol (MTP) | Holcomb JB, et al. PROPPR trial. *JAMA* 2015;313:471-482 (1:1:1 ratio) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/25647203/); CRASH-2 trial collaborators. *Lancet* 2010;376:23-32 (TXA in trauma) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/20554319/); Miller's 10e Ch. 49 "Patient Blood Management" — [Miller's](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0) |
| Venous Air Embolism (VAE) | Miller's 10e Ch. 39 "Anesthesia for Neurosurgery" — [Miller's](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0); Mirski MA, et al. *Anesthesiology* 2007;106:164-177 (VAE diagnosis and management review) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/17197859/) |
| Bronchospasm | Miller's 10e Ch. 13 "Pulmonary Pharmacology" — [Miller's](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0); Stoelting's Pharmacology 6e — [LWW](https://shop.lww.com/Stoelting-s-Pharmacology---Physiology-in-Anesthetic-Practice/p/9781975126896); Albuterol PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=albuterol) |
| Delayed Emergence | Miller's 10e Ch. 84 "Postanesthesia Care" — [Miller's](https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0); Tzabazis A, et al. *J Clin Anesth* 2015;27:353-360 (delayed emergence review) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/25912729/) |

---

## 15. OB Emergencies —  (`obEmergencies`)

| Topic | Source |
|---|---|
| Postpartum hemorrhage (PPH) | ACOG Practice Bulletin 183 — [ACOG](https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage) |
| Eclampsia / Magnesium toxicity | ACOG Practice Bulletin 222 (2020) — [ACOG](https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/06/gestational-hypertension-and-preeclampsia); Magnesium sulfate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=magnesium+sulfate) |
| Placenta accreta | ACOG Obstetric Care Consensus 7 (replaces Committee Opinion 529): Placenta Accreta Spectrum — [ACOG](https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum); SMFM Consult #44 (2018) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/30471891/) |
| Amniotic Fluid Embolism (AFE) | Society for Maternal-Fetal Medicine. *Amniotic fluid embolism: diagnosis and management.* Am J Obstet Gynecol 2016;215:B16-B24 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/26987420/); SMFM publications portal — [SMFM](https://www.smfm.org/publications) |

---

## 16. Infusion Drug Concentrations
Final infusion concentrations and standard mixing instructions reference:
- Institute for Safe Medication Practices (ISMP) Standard Concentrations of Adult Continuous IV Infusions — [ISMP](https://home.ecri.org/pages/ismp)
- Hospital pharmacy formulary standard concentrations (institution-specific)
- Stoelting's Pharmacology, 6th ed — [LWW](https://shop.lww.com/Stoelting-s-Pharmacology---Physiology-in-Anesthetic-Practice/p/9781975126896)
- Individual PIs linked per drug below.

| Drug | Standard infusion conc | Source |
|---|---|---|
| Propofol | 10 mg/mL (1%) stock | Diprivan PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=propofol) |
| Dexmedetomidine | 4 mcg/mL (200 mcg in 50 mL NS) | Precedex PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dexmedetomidine) |
| Ketamine | 1 mg/mL (100 mg in 100 mL NS) | Ketalar PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ketamine) |
| Remifentanil | 50 mcg/mL (5 mg in 100 mL NS, NS only) | Ultiva PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=remifentanil) |
| Fentanyl | 50 mcg/mL (stock) | Sublimaze PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=fentanyl) |
| Sufentanil | 50 mcg/mL (stock) | Sufenta PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sufentanil) |
| Lidocaine | 20 mg/mL (2% stock) | Xylocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine) |
| Rocuronium | 10 mg/mL (stock) | Zemuron PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=rocuronium) |
| Cisatracurium | 2 mg/mL (stock) | Nimbex PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=cisatracurium) |
| Phenylephrine | 100 mcg/mL (10 mg in 100 mL NS) | Neo-Synephrine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=phenylephrine) |
| Norepinephrine | 16 mcg/mL (4 mg in 250 mL D5W; **D5W only**, oxidizes in NS) | Levophed PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=norepinephrine) |
| Epinephrine | 16 mcg/mL (4 mg in 250 mL D5W) | Adrenalin PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=epinephrine) |
| Vasopressin | 1 unit/mL (20 units in 20 mL NS) | Vasostrict / Pitressin PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=vasopressin) |
| Dopamine | 1.6 mg/mL (400 mg in 250 mL D5W) | Dopamine HCl PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dopamine) |
| Dobutamine | 1 mg/mL (250 mg in 250 mL D5W) | Dobutrex / Dobutamine HCl PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dobutamine) |
| Milrinone | 0.2 mg/mL (20 mg in 100 mL NS) | Primacor PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=milrinone) |
| Esmolol | 10 mg/mL (premixed bag 2500 mg/250 mL) | Brevibloc PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=esmolol) |
| Nicardipine | 0.1 mg/mL (25 mg in 250 mL D5W) | Cardene IV PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=nicardipine) |
| Amiodarone | 1.8 mg/mL (900 mg in 500 mL D5W; PVC binds drug — glass preferred) | Cordarone IV PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=amiodarone) |

---

## 17. Awake Fiberoptic
**Topicalization, sedation regimens:**
- Cousins & Bridenbaugh, *Neural Blockade in Clinical Anesthesia and Pain Medicine*, 4e (2009) — [Wolters Kluwer](https://www.wolterskluwer.com/en/solutions/ovid/cousins-and-bridenbaughs-neural-blockade-in-clinical-anesthesia-and-pain-medicine-5380)
- Apfelbaum JL, Hagberg CA, Connis RT, et al. *2022 ASA Practice Guidelines for Management of the Difficult Airway.* Anesthesiology 2022;136:31-81 — [ASA Pubs](https://pubs.asahq.org/anesthesiology/article/136/1/31/117507)
- Glycopyrrolate antisialogogue — Robinul PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=glycopyrrolate)
- Lidocaine topical / nebulized — Xylocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine)
- Dexmedetomidine sedation — Precedex PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dexmedetomidine)

**Lidocaine total dose < 9 mg/kg topical:**
- Williams KA, Barker GL, Harwood RJ, Woodall NM. *Combined nebulization and spray-as-you-go topical local anaesthesia of the airway.* Br J Anaesth 2005;95:549-553 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/16126785/)

---

## 18. Difficult Airway Algorithm
**Primary:** ASA Practice Guidelines for Management of the Difficult Airway 2022.
- URL: https://pubs.asahq.org/anesthesiology/article/136/1/31/117507/2022-American-Society-of-Anesthesiologists

---

## 19. Procedural Sedation
**Primary:** Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force. Anesthesiology 2018;128:437-479.
- URL: https://pubs.asahq.org/anesthesiology/article/128/3/437/19295

**ASA fasting standards (clear liquid 2 hr, etc.):** see Section 12.

---

## 20. Blood Gas Interpretation
Acid-base / oxygenation formulas (Winters, anion gap, A-a gradient, Hb-binding) — references:
- Adrogué HJ, Madias NE. *Management of life-threatening acid-base disorders.* NEJM 1998;338:26-34, 107-111 — [NEJM](https://www.nejm.org/doi/full/10.1056/NEJM199801013810107) · [PubMed](https://pubmed.ncbi.nlm.nih.gov/9414329/)
- Berend K, de Vries APJ, Gans ROB. *Diagnostic use of base excess in acid-base disorders.* NEJM 2018;378:1419-1428 — [NEJM](https://www.nejm.org/doi/full/10.1056/NEJMra1711860) · [PubMed](https://pubmed.ncbi.nlm.nih.gov/29641969/)
- Winters' formula (expected PaCO₂ = 1.5 × HCO₃⁻ + 8 ± 2): commonly attributed to Winters RW, *The Body Fluids in Pediatrics*, Boston: Little, Brown, 1973 (textbook; no online edition). Modern review: Albert MS, et al. *Ann Intern Med* 1967;66:312-322 (original metabolic-acidosis compensation data) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/6016545/)

---

## 21. Adult Drug Reference — Additions

Drugs in [`src/screens/DrugsScreen.jsx`](src/screens/DrugsScreen.jsx) (`drugsData`). Doses derived from FDA package inserts (DailyMed search URLs), standard anesthesia textbooks (Miller's 10e, Stoelting's 6e, Barash 9e), and the trial citations listed where evidence-based dosing applies. Pediatric versions of these drugs live in Section 8.

### Sedation / Premedication
| Drug | Source |
|---|---|
| Midazolam (Versed) | Versed PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=midazolam); Stoelting's 6e — [LWW](https://shop.lww.com/Stoelting-s-Pharmacology---Physiology-in-Anesthetic-Practice/p/9781975126896) |
| Clonidine | Catapres PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=clonidine); Stoelting's 6e |

### Antiarrhythmics & Code Drugs (ACLS doses per AHA 2020)
| Drug | Source |
|---|---|
| Amiodarone | Cordarone PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=amiodarone); AHA ACLS 2020 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/33081529/) |
| Lidocaine (IV antiarrhythmic / analgesic) | Xylocaine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=lidocaine); AHA ACLS 2020 |
| Adenosine (Adenocard) | Adenocard PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=adenosine); AHA ACLS 2020 |
| Magnesium sulfate | Mg sulfate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=magnesium+sulfate); ACOG eclampsia protocol (Section 15) |
| Calcium chloride 10% | CaCl₂ PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=calcium+chloride) |
| Calcium gluconate 10% | Ca gluconate PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=calcium+gluconate) |
| Sodium bicarbonate 8.4% | NaHCO₃ PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sodium+bicarbonate) |
| Dextrose 50% (D50) | Dextrose 50% PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dextrose+50) |

### Volatile anesthetics (see also Section 7)
| Drug | Source |
|---|---|
| Sevoflurane (Ultane) | Ultane PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=sevoflurane); Lerman J, *Anesthesiology* 1994;80:814-824 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/8024136/) |

### Cardiovascular — Vasodilators / Antihypertensives / Diuretic
| Drug | Source |
|---|---|
| Nitroglycerin (NTG) | NTG PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=nitroglycerin); Stoelting's 6e |
| Nicardipine (Cardene IV) | Cardene PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=nicardipine); Stoelting's 6e |
| Furosemide (Lasix) | Lasix PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=furosemide) |

### Hemorrhage / Anticoagulation
| Drug | Source |
|---|---|
| Tranexamic acid (TXA) | CRASH-2 (trauma) — Lancet 2010;376:23-32 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/20554319/); WOMAN trial (PPH) — Lancet 2017;389:2105-2116 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/28456509/); TXA PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=tranexamic+acid) |
| Heparin (unfractionated) | Heparin PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=heparin); ASRA 4e 2018 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/29356773/) |
| Protamine sulfate | Protamine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=protamine); Horrow JC. *Anesth Analg* 1985;64:348-361 (protamine reactions) |

### Hormone / Metabolic
| Drug | Source |
|---|---|
| Insulin (regular) | Humulin R / Novolin R PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=insulin+regular) |

### Antiemetics (full list)
| Drug | Source |
|---|---|
| Ondansetron (Zofran) | Zofran PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ondansetron) |
| Dexamethasone | Decadron PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=dexamethasone); Henzi I, *Anesth Analg* 2000 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/10625002/) |
| Diphenhydramine | Benadryl PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=diphenhydramine) |
| Metoclopramide (Reglan) | Reglan PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=metoclopramide) |
| Famotidine (Pepcid) | Pepcid PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=famotidine) |
| Promethazine (Phenergan) | Phenergan PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=promethazine); FDA pediatric <2 yr black box (2004) |
| Scopolamine (Transderm Scōp) | Transderm Scōp PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=scopolamine) |
| Droperidol (Inapsine) | Inapsine PI (FDA QT black box 2001) — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=droperidol) |
| Aprepitant (Emend) | Emend PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=aprepitant); Apfel CC, *NEJM* 2004;350:2441-2451 (IMPACT trial) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/15190136/) |

### Opioid additions + reversal
| Drug | Source |
|---|---|
| Buprenorphine | Buprenex/Suboxone PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=buprenorphine); Stoelting's 6e |
| Methadone (intraop single dose) | Murphy GS, et al. *Anesthesiology* 2015;122:1112-22 (cardiac surgery cohort) — [PubMed](https://pubmed.ncbi.nlm.nih.gov/25837528/); Dolophine PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=methadone) |
| Meperidine (Demerol) | Demerol PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=meperidine) |
| Naloxone | Narcan/Naloxone PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=naloxone) |
| Flumazenil (Romazicon) | Romazicon PI — [DailyMed](https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=flumazenil) |

---

## Reviewer Audit Log

Independent clinical reviewers who have signed off on sections of this document and have **opted in** to be listed publicly. Reviewers may choose attribution-anonymous review (recorded internally only) — those signatures are not published here.

| Date | Reviewer | Credentials | Affiliation | Sections reviewed | Notes |
|---|---|---|---|---|---|
| _Awaiting first external sign-off_ | | | | | |

To contribute a clinical review, email **clinical@helixanesthesia.com**. Reviewers receive the latest source document, may flag any concern with any cited dose or source, and choose at sign-off whether to be listed in this public log or recorded only in the internal review record.

---

## Appendix: PubMed URLs for cited journal articles

Quick links to all journal articles cited above. URLs go to the PubMed abstract page; full text usually requires institutional login.

| Citation | PubMed URL |
|---|---|
| Apfel CC et al. Anesthesiology 1999;91:693-700 (Apfel PONV score) | https://pubmed.ncbi.nlm.nih.gov/10485781/ |
| Apfel CC et al. NEJM 2004;350:2441-2451 (IMPACT trial) | https://pubmed.ncbi.nlm.nih.gov/15190136/ |
| Lee TH et al. Circulation 1999;100:1043-1049 (RCRI) | https://www.ahajournals.org/doi/10.1161/01.CIR.100.10.1043 |
| Gupta PK et al. Circulation 2011;124:381-387 (Gupta MICA) | https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.110.015701 |
| Chung F et al. Anesthesiology 2008;108:812-821 (STOP-BANG) | https://pubmed.ncbi.nlm.nih.gov/18431116/ |
| Topjian AA et al. Circulation 2020;142:S469-S523 (AHA PALS) | https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901 |
| Carvalho B et al. Anesth Analg 2005;100:1150-1158 (intrathecal morphine) | https://pubmed.ncbi.nlm.nih.gov/15781537/ |
| Kanazi GE et al. Acta Anaesthesiol Scand 2006;50:222-227 (intrathecal dex 3 mcg) | https://pubmed.ncbi.nlm.nih.gov/16430546/ |
| Al-Mustafa MM et al. Saudi Med J 2009;30:365-370 (intrathecal dex 5-10 mcg) | https://pubmed.ncbi.nlm.nih.gov/19271064/ |
| Moore DC, Batra MS. Anesthesiology 1981;55:693-696 (epidural test dose) | https://pubs.asahq.org/anesthesiology/article/55/6/693/29823 |
| Choi S et al. Br J Anaesth 2014;112:427-439 (dexamethasone perineural) | https://pubmed.ncbi.nlm.nih.gov/24413428/ |
| Pöpping DM et al. Anesthesiology 2009;111:406-415 (clonidine perineural) | https://pubmed.ncbi.nlm.nih.gov/19602964/ |
| Candido KD et al. Reg Anesth Pain Med 2002;27:162-167 (buprenorphine perineural) | https://pubmed.ncbi.nlm.nih.gov/11915063/ |
| Abdallah FW, Brull R. Br J Anaesth 2013;110:915-925 (dexmedetomidine perineural) | https://pubmed.ncbi.nlm.nih.gov/23587874/ |
| Karl HW et al. Anesthesiology 1992;76:209-215 (IN midazolam peds) | https://pubs.asahq.org/anesthesiology/article/76/2/209/30801 |
| Yuen VM. Anesth Analg 2007;105:374-380 (IN dexmedetomidine peds) | https://pubmed.ncbi.nlm.nih.gov/17646493/ |
| Mikawa K et al. Anesthesiology 1996;85:954-960 (PO clonidine peds) | https://pubs.asahq.org/anesthesiology/article/85/5/954/35728 |
| Lerman J et al. Anesthesiology 1994;80:814-824 (sevoflurane mask peds) | https://pubmed.ncbi.nlm.nih.gov/8024136/ |
| Mazurek AJ et al. Anesth Analg 1998;87:1259-1262 (rocuronium peds RSI) | https://pubmed.ncbi.nlm.nih.gov/9842809/ |
| Birmingham PK et al. Anesthesiology 1997 (rectal APAP peds) | https://pubmed.ncbi.nlm.nih.gov/9286887/ |
| Henzi I et al. Anesth Analg 2000;90:186-194 (dexamethasone PONV) | https://pubmed.ncbi.nlm.nih.gov/10625002/ |
| Williams RK et al. Anesth Analg 2006;102:67-71 (spinal in infants) | https://pubmed.ncbi.nlm.nih.gov/16368805/ |
| Bösenberg AT et al. Acta Anaesthesiol Scand 2001;45:1276-1280 (caudal ropivacaine pharmacokinetics) | https://pubmed.ncbi.nlm.nih.gov/11736682/ |
| Yukioka H et al. Anesth Analg 1985 (IV lidocaine extubation) | https://pubmed.ncbi.nlm.nih.gov/4061901/ |
| Ouellet MF et al. Can J Anaesth 2023;70:842-850 (propofol bolus for cough at emergence) | https://pubmed.ncbi.nlm.nih.gov/36829104/ |
| Adrogué HJ, Madias NE. NEJM 1998;338:26-34 (acid-base disorders) | https://www.nejm.org/doi/full/10.1056/NEJM199801013810107 |
| Berend K et al. NEJM 2018;378:1419-1428 (base excess) | https://www.nejm.org/doi/full/10.1056/NEJMra1711860 |
| Stevens WC et al. Anesthesiology 1975;42:197-200 (sevoflurane MAC) | https://pubs.asahq.org/anesthesiology/article/42/2/197/26839 |
| Mapleson WW. Br J Anaesth 1996;76:179-185 (MAC age adjustment) | https://pubmed.ncbi.nlm.nih.gov/8777094/ |
| Williams KA et al. Br J Anaesth 2005;95:549-553 (airway topicalization) | https://pubmed.ncbi.nlm.nih.gov/16126785/ |
| Pollock JE. Anesth Analg 2003 (TNS with lidocaine spinal) | https://pubmed.ncbi.nlm.nih.gov/12873924/ |
| Goldblum E, Atchabahian A. Acta Anaesthesiol Scand 2013 (chloroprocaine spinal) | https://pubmed.ncbi.nlm.nih.gov/23320599/ |
| Horlocker TT et al. Reg Anesth Pain Med 2018;43:263-309 (ASRA 4e) | https://rapm.bmj.com/content/43/3/263 |
| Apfelbaum JL et al. Anesthesiology 2022;136:31-81 (ASA Difficult Airway 2022) | https://pubs.asahq.org/anesthesiology/article/136/1/31/117507 |
| ASA Procedural Sedation 2018, Anesthesiology 2018;128:437-479 | https://pubs.asahq.org/anesthesiology/article/128/3/437/19295 |
| ASA NPO Guidelines 2017, Anesthesiology 2017;126:376-393 | https://pubs.asahq.org/anesthesiology/article/126/3/376/19733/ |
| CRASH-2 trial collaborators. Lancet 2010;376:23-32 (TXA in trauma) | https://pubmed.ncbi.nlm.nih.gov/20554319/ |
| WOMAN Trial Collaborators. Lancet 2017;389:2105-2116 (TXA in PPH) | https://pubmed.ncbi.nlm.nih.gov/28456509/ |
| Holcomb JB et al. JAMA 2015;313:471-82 (PROPPR — 1:1:1 transfusion) | https://pubmed.ncbi.nlm.nih.gov/25647203/ |
| Murphy GS et al. Anesthesiology 2015;122:1112-22 (intraop methadone, cardiac) | https://pubmed.ncbi.nlm.nih.gov/25837528/ |
| Mirski MA et al. Anesthesiology 2007;106:164-177 (VAE review) | https://pubmed.ncbi.nlm.nih.gov/17197859/ |
| Tzabazis A et al. J Clin Anesth 2015;27:353-360 (delayed emergence review) | https://pubmed.ncbi.nlm.nih.gov/25912729/ |

### Notes on page numbers

Textbook page numbers vary by edition. Where this document cites a chapter (e.g., "Miller's 10e Ch. 47 'Local Anesthetics'"), the chapter title is the stable reference — find the chapter in your edition rather than relying on a page number. ClinicalKey institutional access provides full text + chapter navigation for Miller's, Coté, and Stoelting's.

---

## Sources without a confirmed direct URL

A small number of cited sources do not have a verifiable direct URL (either pre-internet publications, journals discontinued before PubMed indexing, or society documents distributed only as PDFs to members). For these, I cite the original reference and provide the closest verifiable lookup (society root page or PubMed search):

| Reference | Why no direct URL | Closest verifiable lookup |
|---|---|---|
| Hilgier M. *Reg Anesth* 1985;10:59-61 (sodium bicarbonate alkalinization) | Pre-1990, not indexed in PubMed | No verified direct URL. Topic well-established in regional-anesthesia textbooks (Cousins 4e, Stoelting 6e) |
| Sekerci C, et al. *Br J Anaesth* 1996;76:28-33 (PO ketamine peds) | Indexing inconsistent | [PubMed search](https://pubmed.ncbi.nlm.nih.gov/?term=Sekerci+ketamine+1996) |
| Brown TC, et al. *Anaesth Intensive Care* 1986 (caudal bupivacaine peds) | Pre-1990, no DOI | [PubMed search](https://pubmed.ncbi.nlm.nih.gov/?term=Brown+caudal+bupivacaine+1986) |
| Liu LM, et al. *Anesthesiology* 1981 (succinylcholine IM peds) | Limited PubMed coverage | [PubMed search](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+succinylcholine+IM+1981) |
| Bhana N, et al. *Drugs* 2000 (dexmedetomidine review) | Review article, behind publisher paywall | [PubMed search](https://pubmed.ncbi.nlm.nih.gov/?term=Bhana+dexmedetomidine+Drugs+2000) |
| Salinas FV. *Anesth Analg* 2004 (mepivacaine spinal) | Could not confirm exact 2004 citation; cited Zayas VM et al. 1999 mepivacaine dose-response instead | [Zayas PubMed](https://pubmed.ncbi.nlm.nih.gov/10553828/) |
| Winters RW. *Body Fluids in Pediatrics* 1973 (Winters' formula) | Pre-internet textbook, no online edition | Original Albert 1967 data — [PubMed](https://pubmed.ncbi.nlm.nih.gov/6016545/) |
| AAAAI 2020 Practice Parameter (anaphylaxis) | Society document distributed via journal, not as standalone webpage | Shaker MS, et al. JACI 2020;145:1082-1123 — [PubMed](https://pubmed.ncbi.nlm.nih.gov/32001253/); AAAAI portal — [aaaai.org](https://www.aaaai.org/practice-resources/statements-and-practice-parameters) |
| Hospital pharmacy formulary concentrations (Infusion screen mix instructions) | Institution-specific documents | ISMP Standard Concentrations of Adult Continuous IV Infusions — [ISMP](https://home.ecri.org/pages/ismp) |

If you have a verifiable direct URL for any of the citations above, please email **clinical@helixanesthesia.com** so we can add it.