Midazolam effects cerebral metabolic oxygen requirement (CMRO2) by decreasing it and cerebral blood flow, analogous to barbiturates and propofol. It causes dose-related changes in regional cerebral blood flow in brain regions associated with the normal functioning of arousal, attention, and memory. Patients with decreased intracranial compliance show little or no change in intra-cranial pressure when
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
Based on the pharmacokinetic parameters and reported clinical experience in preterm and term midazolam in neonates , continuous IV infusion of midazolam should be initiated at a rate of 0.0005 to 0.001 mg/kg/mm (0.5 to 1 mcg/kg/min). IV loading doses should not be used with midazolam in neonates ; rather the infusion may be run
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
The molecular mechanisms underlying the diverse actions remain unclear, although some of the midazolam mechanism of action and sites of action of benzodiazepines effects are known. Benzodiazepines appear to produce all their pharmacologic effects by facilitating the actions of gamma-aminobutyric acid (GABA), the principal inhibitory neurotransmitter in the CNS. Benzodiazepines do not activate the GABAA
Treatment modalities in pain management play an important role when dealing with different circumstances which include the following : 1. Treatment of Disease (Cancer) in pain management : After the diagnosis and confirmation, appropriate therapy has to be started, especially for symptom ‘pain’. Symptom like mucositis, dysphagia etc, can be controlled by using local anesthetics,
The pharmacodynamics of inhaled anesthetics is discussed here in detail. The action of inhalation agents are as follows: I. Pulmonary effects 2. Cardiovascular effects 3. Metabolism 4. Toxicity Pulmonary Effects: For pharmacodynamics of inhaled anesthetics , the pulmonary effects of inhalation agents are many and important as this is the portal of entry. There are
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
Midazolam infusion can be used either alone or combined with a narcotic immediately before the procedure, with supplemental doses to maintain the desired level of sedation throughout the procedure. For short endoscopic or short diagnostic procedures and direct current cardioversion, midazolam infusion of 1 mg/mL formulation is recommended for IV sedation to facilitate slow injection.
Nitroprusside Cyanide Toxicity is due to the cyanide groups released from metabolism of the nitroprusside molecule. After gaining an electron from the iron moiety of hemoglobin, the sodium nitroprusside produces an unstable radical and methemoglobin. Hypertension is commonly seen in the perioperative setting as well as the intensive care unit (ICU). There are many agents
