Pain control is an important aspect of critical care medicine and the use of opiate medications has typically been an important method of achieving control in the intensive care unit (ICU) setting. The brain has four opiate receptors that include the mu, kappa, delta, and sigma receptors. Currently used opioid analgesics bind to the mu
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 most significant Methodone feature is its exactly identical pharmacodynamics and methodone mechanism of action as that of morphine in equipotent (equianalgesic) doses. Methodone is an agonist with diphenyl structure (2 phenyl rings at the center). The psychological behaviour of methadone addiction is not as markedly abnormal as that of other pure agonists like heroin,
Benzodiazepine half life is commonly administered through oral, intramuscular and intravenous routes. Intramuscular absorption of diazepam is erratic, whereas midazolam and benzodiazepine half life have good bioavailability through this route. Diazepam and lorazepam are well absorbed from gastrointestinal tract. However, meals and antacids may decrease absorption from the gastrointestinal tract. Midazolam has also been used
Subhypnotic doses of IV like Propofol 10 mg have been used to treat pruritus caused by neuraxial opioids. However, this beneficial effect has not been achieved in other studies. Propofol has been shown to possess antipruritic effect. Subhypnotic doses of propofol may be effective for the short-term symptomatic relief of pruritus associated with liver disease. Such
Midazolam can be used intravenously for induction of anesthesia versed . As an inducing agent it produces sleep and amnesia but it does not have any analgesic effect. Midazolam is not as rapid acting as thiopental. At approximately equipotent doses (loss of consciousness), thiopental abolishes the eyelash reflex 50—100% faster than midazolam, but it produces
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
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
Propofol contamination in an emulsion formulation, has been associated with infective complications. It becomes contaminated once the ampoules have been opened. Propofol contamination supports the growth of all microorganisms. Diphtheroid bacilli and coagulase-negative staphylococci were the most frequent microorganisms. Others are E. coli, S. aureus, and P. aeruginosa. Adding lidocaine, or storing opened ampoules at
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
