Pain is a personal and subjective experience of each individual. Objectivity in such situation of acute pain management techniques is very difficult. So the best way out of this is: “If patient says it hurts, then it hurts!” After accepting the pain, then try to quantify or assess the severity of the pain using acute
Bradycardia and asystole have been observed after induction of anesthesia with propofol. The risk of propofol bradycardia related death during propofol anesthesia has been estimated to be 1.4 in 100,000. Severe, refractory, and fatal bradycardia has been observed with long-term propofol bradycardia infusion. In contrast to thiopentone, propofol apparently lacks central vagolytic activity and may
Midazolam onset of action undergoes rapid absorption from gastrointestinal tract. Only about 50% of the orally administered dose of midazolam reaches the systemic circulation, reflecting extensive first-pass metabolism. It is highly protein bound and this does not depend on the plasma concentration of the drug. The short duration of the drug is due to its
The most commonly used barbiturate is pentobarbital. Induced coma with use of barbiturates like thiopentone sodium or pentothal is called barbiturate coma or pentobarbital coma . High-dose barbiturates have been used for more than 60 years in critically ill neurologic patients. The most common application has been to lower elevated intracranial pressure (ICP) in patients
Aging and liver disease affect glucuronidation less than oxidative metabolic pathways. And thus, lorazepam, oxazepam, benzodiazepines in the elderly and temazepam are preferentially used in elderly patients over other benzodiazepines as they are metabolized only by glucuronidation and have no active metabolites. Elderly patients may also be intrinsically sensitive to benzodiazepines, suggesting that the enhanced
The sedative effect of benzodiazepines and opiods is potentiated by other CNS depressants including alcohol, barbiturates, inhaled and injected anesthetics, and opioids. Anesthetic requirements for inhaled and injected anesthetics are decreased by benzodiazepines and opiods . Benzodiazepines decrease the MAC value of inhaled anesthetics. Benzodiazepines, especially midazolam, potentiate the ventilatory depressant effects of opioids, though
Barbiturates list is explained in detail in this article. Thiopentone is prepared commercially from highly alkaline solutions as sodium salt that is readily soluble in water or saline. It is supplied as a yellowish, hygroscopic powder. The pH of a 2.5% solution of thiopental is 10.5. The following is a list of Barbiturates in common
Clonidine is an alpha-2 receptor agonist that down regulates the sympathetic nervous system. By stimulating alpha-2 adrenergic receptors in the brain stem, clonidine activates inhibitory pathways in the central nervous system (CNS), which results in reduced catecholamine release and reduced sympathetic outflow from the CNS. This effectively causes a decrease in blood pressure, heart rate,
All of these nonsteroidal anti inflammatory drugs side effects collectively lead to breach of the integrity of gastric mucosal lining, and gastric ulceration is the result. Following are the nonsteroidal anti inflammatory drugs side effects : Gastritis : As an overall decrease in production of prostaglandins takes place. Some of the protective PGs like PGE1, PGE2,and
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Based on the pharmacokinetic parameters and reported clinical experience in preterm and term midazolam in neonates , continuous IV infusion of midazolam should be initiated at a rate of 0.0005 to 0.001 mg/kg/mm (0.5 to 1 mcg/kg/min). IV loading doses should not be used with midazolam in neonates ; rather the infusion may be run
