Ketamine is metabolized extensively by hepatic microsornal enzymes. Ketamine metabolism is demethylated to the corresponding N-desmethyl compound to form norketamine (about 60%) the main metabolite. Norketamine rapidly appears (approximately within 5 minutes) in plasma following ketamine administration and had a terminal half-life of 63.6 +1- 23.9 minutes. In animals, norketamine is one-fifth to one-third as
Of interest to the clinicians is that, while appearing minimally responsive to endogenous BNP, heart failure patients will effectively respond to exogenously administered BNP which is nesiritide drip. In patients with cardiogenic pulmonary edema due to acute decompensated heart failure, plasma brain natriuretic peptide (BNP) measurements can guide the diagnosis, distinguishing this etiology of dyspnea
From time immemorial mankind has been aware of opium classification . The word opium itself is derived from Greek word for juice. Arabian traders popularized it and introduced it to Europe. Paracelsus (1493—1541) reintroduced it and made it popular. It was at one time considered as “God’s own medicine” and used in various remedies from
Clonidine is an alpha-2 receptor agonist that down regulates the sympathetic nervous system. By stimulating alpha-2 adrenergic receptors in the brain stem, clonidine activates inhibitory pathways in the central nervous system (CNS), which results in reduced catecholamine release and reduced sympathetic outflow from the CNS. This effectively causes a decrease in blood pressure, heart rate,
This butorphanol drug class was introduced about 25-30 years back. That was the era of morphine, pethidine, so it did not gain much acceptance. But now re-introduced, has become a major “find”. It is a classical example of “resurrection”. Butorphanol is a morphinan derivative with spectrum of activity almost like pentazocine, only that it is 20
Ketamine Preemptive Analgesia is an antinociceptive treatment targeted to block CNS hyperexcitability, and thereby leads to a reduced postoperative pain state. Excitatory amino acids aspartate, released by the C fibers, interacts with the NMDA receptors of the dorsal horn neurons, and thus, leads to increase in intracellular calcium ions, which is thought to be the
Hypnotherapy placebo effect therapy most probably acts via, placebo effects/auto suggestion mechanisms. Anaesthesiologists have been practicing some form of suggestion therapy even in their day-to-day preoperative visits on the eve of surgery. Even a 5-minute preoperative visit will reduce anxiety of patient significantly. Hypnotherapy placebo effect or what was called mesmerism was described in late
Lasix is known to cause Sulfa allergy. The decrease in sodium and chloride reabsorption seems to come from the fact that furosemide competes for the chloride position on the carrier. Furosemide (Lasix) is a member of the general class of loop diuretics that inhibit the Na+/K+/2Cl–cotransport carrier within the ascending limb of the loop of
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
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
