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 […]
The Etomidate brand name in common use is Amidate. Amidate is a carboxylated imidazole compound. The imidazole nucleus renders etomidate, like midazolam, water soluble at an acidic pH and lipid soluble at physiologic pH. It is a non-barbiturate hypnotic without analgesic properties that has less cardiovascular and respiratory depressant actions than sodium thiopental. This lipophilic
The drugs remain the main modality to achieve pharmacological management of pain . Various routes of administration for various drugs have been employed. The quest for an ideal, suitable analgesic continues. Conventionally three classes of drugs are employed to achieve various degrees of analgesia in pharmacological management of pain : 1. Opioids: For a long time
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
Here we study about the physical effects of barbiturates . In normovolemic subjects, thiopental, 4-5 mg/kg IV, produces a transient mild to moderate decrease in blood pressure with a compensatory increase in heart rate. However, bradycardia and junctional rhythm may occur with thiopentone. This dose of thiopental produces minimal to no evidence of myocardial depression.
Diazepam remains a popular oral drug for preoperative medication of adults and is the benzodiazepine most likely to be selected for management of delirium tremens and treatment of local anesthetic induced seizures. This is considered to be one of the diazepam uses that are very common. Production of skeletal muscle relaxation by diazepam is often
Midazolam IV is the first benzodiazepine that was produced primarily for use in anaesthesia. Walser and colleagues in 1976 “first described midazolam, the first clinically used water-soluble benzodiazepine. The imidazole ring in its structure accounts for its stability in aqueous solution and rapid metabolism. It is two to three times as potent as diazepam and
Midazolam produces dose-dependent decrease in ventilation with 0.15 mg/kg IV producing effect similar to diazepam 0.3 mg/kg IV. Patients with chronic obstructive pulmonary disease experience even greater midazolam respiratory depression . Transient apnoea usually follows after rapid injection of large doses of midazolam (>0.15 mg/kg IV) especially in the presence of premedication with opioids. The
Neo-Synephrine is the trade name for phenylephrine. It is a pure alpha receptor agonist and has both venous and arterial constrictive effects. Because Alpha1 receptors have been discovered in the myocardium, it is also possible that it has positive inotropic effects. In our current culture of patient safety, it is important to avoid commonly used medical
The phencyclidine derivatives Ketamine anesthetic is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist. It produces “dissociative anesthesia”, characterized by evidence on the EEG of dissociation between the thalamo-cortical and limbic systems and a cataleptic state in which the eyes remain open with a slow nystagmic gaze. The patient becomes noncommunicative with an apparent wakefulness state. It
