Critically ill patients often require cardiac inotrope and/or cardiac pressors support to maintain adequate cardiac output and adequate blood pressure to sustain end-organ perfusion. Because end-organ perfusion has already likely been compromised and may continue to be problematic despite use of these agents, anaerobic metabolism rather than aerobic metabolism is likely to be generating a […]
Barbiturates mechanism of action is described here. Barbiturates most likely produce their sedative hypnotic effects through an interaction with the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the CNS. Barbiturates cause reversible depression of all excitable tissues, the CNS being exquisitely sensitive. They bind to beta subunit of the inhibitory GABA-A receptor, a site distinct from
For the phenobarbital metabolism the binding of thiopentone in human serum is about 85% and remarkably constant over the concentration range between 4 and 80 micrograms/mL. The higher percentage of protein binding occurs at lower plasma concentrations of thiopental In phenobarbital metabolism . The percentage binding increases with increasing pH from approximate 75% at pH
Beta blockade prior to instituting other vasodilator drugs in aortic dessection management is essential. The following case presentation demonstates the importance of beta blockade in Aortic dissection management. A 44-year-old man whose only past medical history consists of hypertension and unilateral cataracts presents to his local emergency department with the acute onset of severe tearing
For the Barbiturate therapy , High-dose barbiturates appear to be useful adjuncts in the control of intracranial hypertension refractory to other methods of therapy. Barbiturates decrease ICP by decreasing cerebral blood volume through drug-induced cerebral vascular vasoconstriction and an associated decrease in cerebral blood flow. This therapy in used either as a anti seizure medication
Cause of hypoxia Common cause of hypoxia and Cyanosis are : 1. Factors present before the operation • Oedema of glottis • Ludwig’s angina • Bilateral quinsy 2. Carcinoma of larynx 3. Tracheal compression and stenosis due to any cause 4. Foreign body in bronchus 5. Carcinoma of bronchus 6. Acute or chronic bronchial asthma
S-Ketamine is a water soluble molecule that structurally resembles phencyclidine. The commercial preparation of S-Ketamine is a racemic mixture of two optical enantiomers R(-) and S(+), and a preservative benzethonium chloride. The presence of asymmetric carbon atom results in the existence of two optical isomers of ketamine. The racemic form of ketamine has been the
Inhalation anesthetic mechanism of action after being administered and excreted via the lungs. The dose of the agent is defined by the fraction of inhaled concentration that equates with the blood concentration and not the total amount of drug administered. The minimum alveolar concentration (MAC) was introduced in 1963 as a comparison of potency of
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
Lorazepam drip or Ativan drip is a frequently used sedative in the intensive care unit (ICU). It is a benzodiazepine that can be administered enterally, as intermittent parenteral doses, or as a continuous infusion. The beneficial effects of lorazepam drip include anterograde amnesia and an opioid-sparing effect via a moderation of the anticipatory pain response.
