Phenobarbital status epilepticus that does not respond to first-line benzodiazepines (lorazepam or diazepam) or to second-line antiepileptic drugs (phenytoin/fosphenytoin, phenobarbital or valproate) is usually considered refractory and requires more aggressive treatment. Barbiturate anaesthetics, such as pentobarbital and thiopental sodium, are the most frequently used agents and are highly effective for refractory GCSE both in children […]
The chronic pain syndrome pathophysiology is disturbance in the process of acute nociception. The processes of transduction, transmission, modulation and perception have somehow got disturbed. The pain stimuli which were supposed to be sent forward before closing of gate, get more and more intensely forwarded rather than getting modulated. In addition, due to sustained partial
Commonly administered IV anesthetics can cause excitatory effects that my manifest as spontaneous movements, such as etomidate myoclonus ,dystonia, and tremor. These spontaneous movements, particularly myoclonus, occur in 50% to 80% of patients receiving etomidate in the absence of premedication. In one report, 87% of patients receiving etomidate developed excitatory effects, of which 69% were
Visual analogue scale for pain intensity is a numerical pain rating scale which uses a 10 cm line with the numbers ranging from 0-10. Patients points out the number that corresponds to the level of pain they are feeling. The significance of the numbers must be explained to the patient. Intensity of the pain is
Diazepam metabolism is carried out by hepatic microsomal enzymes using an oxidative pathway of N-demethylation with the production of desmethyldiazepam, oxazepam, and to a lesser extent temazepam as metabolites. Desmethyl diazepam is metabolized more slowly than oxazepam and is only slightly less potent than diazepam. These metabolites contribute to the sustained effect of diazepam. The
Etomidate shortens the onset time of the neuromuscular block with vecuronium. This etomidate drug interactions enhances the bradycardia induced by vecuronium. Miller’s anesthesia says the following about etomidate drug interactions – The specific endocrine effects manifested by etomidate are a dose-dependent reversible inhibition of the enzyme 11β-hydroxylase, which converts 11-deoxycortisol to cortisol, and a relatively minor
The midazolam dose must be carefully individualized. In elderly and debilitated patients, lower doses are required. The midazolam dose should further be adjusted according to the type and amount of premedication used. Excess doses or rapid IV administration may result in respiratory depression and/or arrest, particularly in elderly or debilitated patients. For IM use, midazolam
Barbiturate drugs are defined as any drug derived from barbitunc acid. Barbituric acid, which lacks central nervous system (CNS) activity, is a cyclic compound obtained by the combination of urea and malonic acid. Barbiturate drugs with sedative hypnotic properties result from substitutions at the number 2 and 5 carbon atoms of barbituric acid. Barbiturates that
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
Ketamine is associated with psychedelic effects and dependence. Well the question here arises is that Is Ketamine addictive ? These effects are dose-related and comprised of multimodal hallucinatory experiences, a sense of slowing, paranoid ideation and enhancement of sexual, musical and sensory enjoyment. The mechanisms of these phenomena are largely due to its complex multi-receptors
