Epidural ketamine and its active enantiomer S(+)ketamine have been used intrathecally and epidurally (caudally) for the management of perioperative pain and in a variety of chronic pain syndromes. Although ketamine has been reported to interact with opioid receptors, binding to local opiate receptors seems to play only a minor role, whereas significant analgesia after even […]
Of interest to the clinicians is that, while appearing minimally responsive to endogenous BNP, heart failure patients will effectively respond to exogenously administered BNP which is nesiritide drip. In patients with cardiogenic pulmonary edema due to acute decompensated heart failure, plasma brain natriuretic peptide (BNP) measurements can guide the diagnosis, distinguishing this etiology of dyspnea
Propofol mechanism of action exerts its sedative hypnotic effects through a GABA receptor interaction. GABA is the principal inhibitory neurotransmitter in the CNS. When GABAA receptors are activated, transmembrane chloride conductance increases, resulting in hyperpolarization of the postsynaptic cell membrane and functional inhibition of the postsynaptic neuron. The interaction of propofol mechanism of action also
Some Etomidate side effects are explained here. Some Patients receiving etomidate as intravenous injection for induction, frequently complain about pain. The incidence of pain is about 20% and associated with the conventional formulation due to its solvent propylene glycol which causes direct injury to vascular endothelium resulting in pain and venous sequelae. Pain on injection
As a group, paediatric patients generally require higher doses of midazolam than do adults and younger children may require higher doses than older children. In obese individuals, the midazolam syrup dose should be calculated based on ideal body weight. Oral premedication: Oral midazolam syrup is effective for sedation and anxiolysis at the doses of 0.25—1
The pharmacokinetics of inhaled anesthetics are explained here with detail • Absorption of agent from alveoli to blood • Distribution in the body • Metabolism (liver) • Elimination (lungs mainly) Uptake and Distribution The pharmacokinetics of inhaled anesthetics depends upon: (1) Respiratory uptake, (2) Alveolar ventilation, (3) The partial pressure of the agent in the
Midazolam structure is characterized by pH dependent ring opening phenomenon in which the ring remains open at pH values of less than 4, thus maintaining its water solubility. The pK of midazolam is 6.15, which permits the preparations of salts to be water soluble. The parenteral solution of midazolam used clinically is buffered to an
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
Etomidate pharmacology is studied using following points. In etomidate pharmacology we find that Etomidate is a potent, direct cerebral vasoconstrictor. It decreases cerebral blood flow and CMRO2 in an independent manner. The cerebral metabolic effects of etomidate are secondary to its effect on neuronal function. As a result, previously increase ICP is lowered by etomidate
Lasix is known to cause Sulfa allergy. The decrease in sodium and chloride reabsorption seems to come from the fact that furosemide competes for the chloride position on the carrier. Furosemide (Lasix) is a member of the general class of loop diuretics that inhibit the Na+/K+/2Cl–cotransport carrier within the ascending limb of the loop of
