The key to a successful Acute Pain Service is not so much the use of sophisticated drugs and high technology equipment, but an excellent organisational structure and well trained medical and nursing personnel.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
BUPIVACAINE epidural effectiveness has a clearly scientific evidence for perioperative analgesia
Bupivacaine epidural still safe in a wide range dose to cause systemic toxicity
We always reduce the risk of LA toxicity by our usually practice procedures
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
BUPIVACAINE epidural effectiveness has a clearly scientific evidence for perioperative analgesia
Bupivacaine epidural still safe in a wide range dose to cause systemic toxicity
We always reduce the risk of LA toxicity by our usually practice procedures
Los analgésicos opioides se caracterizan por poseer afinidad selectiva por los receptores opioides. La activación de estos receptores causa analgesia de elevada intensidad, producida en el sistema nervioso central (SNC), así como otros efectos subjetivos que tienden a favorecer la instauración de una conducta de autoadministración denominada farmacodependencia. Su representante principal es la morfina, alcaloide pentacíclico existente en el opio, jugo extraído de la adormidera (Papaverum somniferum).
Aggressive preemtive multimodal including epidural or nerve block not only produce optimal analgesia but also may prevent the occurrence of chronic pain after surgical
Paracetamol as a single analgesic is only for mild and moderate pain.
However it can be combined with many analgesics to provide strong effect.
So, it can be the basic regiment for Multimodal Analgesia.
Peran Fentanyl pada balance anestesia -> telah banyak diteliti hasilnya adanya potensiasi fentanyl dengan obat anestesia baik inhalasi maupun intravena. Berikut ini kami mencoba menelaah beberapa penelitian dari luar maupun penelitian yang kami lakukan sendiri.
Paracetamol iv as a single analgesic is very safe analgesic, but only for mild and moderate pain.
It can be combined with many analgesic or adjuvan drugs to provide strong analgesic for postoperative pain.
So, it can be the basic regiment for Multimodal Analgesia.
Because of its safety it can be the choice for high risk surgical patient
Acute neuropathic pain - Stephan Schug - SSAI2017scanFOAM
A talk by Stephan Schug at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
PCA is neither “ one size fits all “ or a “ set and forget “ therapy
An Anesthesiologist style ……….
no fixed dose of drug fits all patient
make patient analgesia and take care
An analgesic drug, also called simply an analgesic, pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain. It is typically used to induce cooperation with a medical procedure.
Similar to Fentanyl for perioperative pain management - Dr. Alex Yeo Sow Nam (20)
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
INADEQUATE PAIN TREATMENT STILL A FACT IN INDONESIA HEALTH SERVICES
PAIN AS A COMPLEX PROBLEM NEED MULTIDISCIPLINARY APPROACH FOR BETTER RESULT BASED INDIVIDUALLY PATIENT NEEDED
THERE IS A BIG ROLE OF PHYSICIAN AND HOSPITAL FOR BETTER PAIN MANAGEMENT
CHANGE PARADIGM TO MULTIDISCIPLINARY PAIN TREATMENT IS AN OBLIGATE FOR ALL PHYSICIAN
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Pain is the production (out put ) of the brain.
Pain is invisible disease, we can’t see it like other disease, such as struma, fracture or blind.
What you have to do is to believe what ever the patient says.
Pain is what ever the patient says it is
Pain is invisible diseases, but is real for patient.
NUTRITIONAL THERAPY IN CRITICAL ILL PATIENTS
However, significant barriers can impede the enteral administration of nutrients, including gastroduodenal dysfunction reflected by high gastric residual volumes, and diarrhoea and constipation.
Possible solutions are suggested. In case of contraindication or failure of enteral nutrition, parenteral nutrition is indicated -----as a replacement or a supplement to failing enteral feeding.
The perfect timing of supplemental parenteral nutrition (early or late) remains uncertain, and parenteral nutrition should be carefully monitored
Solution of inadequate postoperative pain relief lies in developing Acute Pain Service.
APS has been shown to reduced morbidity and
mortality, increased out put and out come of
postoperative pain patients
Increased stisfaction of the patients
Shorten LOS in ICU and Hopital low cost
Nyeri adalah penggabungan perasaan sensorik dan emosional yang dipengaruhi oleh berbagai faktor.
Nyeri memiliki dua dimensi yg jelas, dimensi inderawi dan emosional
Peran dimensi emosional lebih dominan dibanding inderawi utamanya pada nyeri kronik.
History taking
Adequate time
Listen carefully
Empathetic
Trust building
Do not intervere
Pschosocioeconomic & spiritual codition
- quantity: VAS
- quality: nociceptive
- mode of onset and location
- duration & chronicity
- provocating & relieving factors
- special character
- timing of pain
- relation with posture
- associated complaints
Take home message
Acute pain is a symptom, tell us that there is something wrong in our body.
Chronic pain is a disease entity and that must be treated differently to acute pain.
Since chronic pain is biopsychosocial phenomenon it must be treated by multidisciplinary team with multidisiplinary approach.
Clossing
By 3 step ladder WHO cancer pain management, 90 % of cancer pain can be relief.
Since cancer patients cannot be cured, our main task is to let them die free of pain with Iman
Ideal pain clinic
Promoting multidisciplinary team approach
Coordinating all specialist effort
Measuring the outcome of treatment offered
Promoting palliative model rather than curative models of pain treatments
Identifying complications of IPM and promoting safe and base-evidence intervention
PiCCO tidak hanya memberikan informasi tentang curah jantung (CO) tapi bisa memberi pengukuran untuk menilai preload, kontraktilitas, afterload, dan air paru ekstravaskular (ELWI)
Role of the thalamus in propofol-induced unconsciousness relates primarily to the functional connections of nonspecific nuclei to the cortex (i.e., mediating multimodal integration of information)
The Anesthetized Brain is less Vulnerable to ischemic injury than the awake brain.
EEG changes suggestive of severe ischemia are present.
Basic Methode Brain Protection are “ Corner Stone “
CPP, CBF, CBV maintained in “Normal Range”, MAP may increased up to 10 – 20 %.
Anesthetics Drugs may have Brain Protectection effect.
Volatile anesthetics do provide some Transient Protection (< 1,5 MAC)
Barbiturates, although long considered to be the gold standard.
Hypothermic methode are controversial, Hyperthermia should be avoided.
Insulin is Administered if glucose values exceed 180 mg/dl.
Close monitoring of BSL to ensure that Hypoglycemia does not develop
Anesthesiologists should concern about the risk of POCD by making prevention and attentive to the potential risk factors.
It should be remembered that research in animal models which represent the specific characteristics of POCD in human remains unclear.
With many factors still unknown, there is still a chance for sinchronized preclinical and clinical research on POCD.
a better understanding of sleep and coma may lead to new approaches to general anesthesia based on new ways to alter consciousness,29,97,98 provide analgesia,99,100 induce amnesia, and provide muscle relaxation.66
More from Department of Anesthesiology, Faculty of Medicine Hasanuddin University (20)
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
4. The key to a successful Acute Pain
Service is not so much the use of
sophisticated drugs and high
technology equipment, but an excellent
organisational structure and well
trained medical and nursing personnel.
5. Acute Pain Services
“Postoperative Rehabilitation Service”
(H. Kehlet 1995)
Multidisciplinary care of postoperative patients
with utilisation of optimal pain therapy to achieve
reduction of postoperative morbidity, mortality and
hospital stay:
• multimodal pain therapy
• early aggressive mobilisation
• early enteral feeding
• early and organised discharge from hospital
6. Acute Pain Services
“Comprehensive Pain Service”(Cousins1996)
Treatment of in-patients with pain of any
origin in close cooperation with a
multidisciplinary pain clinic:
• postoperative pain
• posttraumatic pain
• subacute pain
• chronic pain
• cancer pain
7. ParacetamolParacetamol
neglected analgesic
minimal side effects
more useful if given regularly
daily 90 mg/kg (6 g/day – 1 g/4hrs)
careful in
Malnourished patients
Alcoholics
Hepatic impairment
Standard Operating Procedures, APS, RPH
8. NSAIDsNSAIDs
Not a routine prescription!
Extreme care in
Elderly
Renal problems
Expected hypovolaemia/hypotension
Combination with other renal toxic agents
Patients in whom bone repair is essential
If Nil By Mouth: parecoxib 40 mg/BD
Then naproxen 250-500 mg BD
If contraindications, celecoxib 100-200 mg BD
Prescribe time limit for regular intake!
Standard Operating Procedures, APS, RPH
9. Parenteral OpioidsParenteral Opioids
PCA preferred route of administration
Intravenous infusion if patient
Unable to use PCA
– Comprehension
– Mechanics
– Psychology
Bolus doses better SC than IM
Discourage IM use!!!!!
10. ’’10 mg morphine10 mg morphine IMIM PRN 4hrly’PRN 4hrly’
Delayed onset of action
Unpredictable absorption
Site of injection
Muscle perfusion
Potential for nerve damage
Potential for infection
Discomfort for patient
11.
12. Why then ‘IM” ?Why then ‘IM” ?
Nursing tradition: No IV injections
Risk of adverse effects?????
Belief: Parenteral is better than oral!
Why?
13. ’’10 mg morphine10 mg morphine IMIM PRN 4hrly’PRN 4hrly’
Standard dose fits all!
Too low for many!
Too strong for others!
Contradicts data on analgesic
requirements!
14.
15. 6 8 10 12 14
Theoretical Relation Between AnalgesicTheoretical Relation Between Analgesic
Drug Level, Dosing Interval, and ClinicalDrug Level, Dosing Interval, and Clinical
ResponseResponse
Pain
Analgesia
Sedation
Ferrante FM, et al. Anesth Analg. 1988;67:457-61.
Analgesicdrug
concentration
Time (hours)
Dose Dose Dose
Dose
Minimum
analgesic
concentration
IM
PCA
IM=intramuscular; PCA=patient controlled analgesia
16. Patient Controlled AnalgesiaPatient Controlled Analgesia
Principles
– Small IV bolus!
– Lockout interval appropriate to route
of administration!
– Patient titrates amount needed against
pain experienced!
17. Principle Concept of TitrationPrinciple Concept of Titration
P a t ie n t e x p e r ie n c e s e ffe c t o f d r u g
D r u g w o r k s
P a t ie n t a d m in is t e r s d r u g
P a t ie n t e x p e r ie n c e s p a in
Good pain relief?
Wait!
Yes No
18. Opioids via PCAOpioids via PCA
Routinely no background infusion
Exceptions:
– Previous long-term opioid use
– Established high usage
No 4 hr dose limit
5 min lockout time in most cases
Standard Operating Procedures, APS, RPH
19. Pethidine PharmacologyPethidine Pharmacology
Pethidine also has structural similarities to
atropine and other tropane alkaloids and may
have some of their effects and side effects.
Unlike morphine, a potent mu opioid receptor
agonist, pethidine exerts its analgesic effects
by acting as an agonist at the
kappa opioid receptor, primarily.
In addition to its anticholinergic effects, it has
local anesthetic activity related to its
interactions with sodium ion channels
"The cocaine-like behavioral effects of meperidine are mediated by activity at the
dopamine transporter". . Izenwasser, Sari et. Al. European Journal of Pharmacology
(January/February 1996). 297 (1-2): 9–17
20. Pethidine PharmacologyPethidine Pharmacology
It has also been associated with cases of
serotonin syndrome, suggesting some interaction with
serotonergic neurons,
It is more lipid-soluble than morphine, resulting in a
faster onset of action.
Its duration of clinical effect is 120–150 minutes
although it is typically administered in 4-6 hour
intervals. Pethidine has been shown to be less
effective than morphine, diamorphine or
hydromorphone at easing severe pain,
"Meperidine: A Critical Review". Latta, Kenneth S.; Brian Ginsberg, Robert
L. Barkin American Journal of Therapeutics (Lippincott Williams &
Wilkins) January/February 2002). 9 (1): 53–68.
21. Pethidine's apparent in vitro efficacy as an "
antispasmodic" is due to its local anesthetic
effects. It does not, contrary to popular
belief, have antispasmodic effects in vivo.
"Meperidine and Lidocaine Block of Recombinant Voltage-
Dependent Na+
Channels: Evidence that Meperidine is a Local
Anesthetic". Anesthesiology 91 (5): 1481–1490. Wagner, Larry E.,
II; Michael Eaton, Salas S. Sabnis, Kevin J. Gingrich (November
1999)
22. Pethidine is no more effective than morphine
at treating biliary or renal pain, and its low
potency, short duration of action, and unique
toxicity (i.e., seizures, delirium, other
neuropsychological effects) relative to other
available opioid analgesics have seen it fall out
of favor in recent years for all but a very few,
very specific indications.
"Subjective, Psychomotor, and Physiological Effects of Cumulative Doses of Opioid
µ Agonists in Healthy Volunteers". The Journal of Pharmacology and Experimental
Therapeutics (American Society for Pharmacology and Experimental Therapeutics)
Walker, Diana J.;et al (June 1999). 289 (3): 1454–1464
23. Australia, has put strict limits on its use.
Nevertheless, some physicians continue to use it
as a first line strong opioid.
Use of pethidine for pain management in the emergency department:
a position statement of the NSW Therapeutic Advisory Group"
New South Wales Therapeutic Advisory Group.. Retrieved 2007-
01-17
24. Adverse effectsAdverse effects
opioids as a class: nausea, vomiting, sedation,
dizziness, diaphoresis, urinary retention and
constipation. Unlike other opioids, it does not cause
miosis. Overdosage can cause muscle flaccidity,
respiratory depression, obtundedness, cold and
clammy skin, hypotension and coma. A narcotic
antagonist such as naloxone is indicated to reverse
respiratory depression.
Serotonin syndrome has occurred in patients
receiving concurrent antidepressant therapy with
selective serotonin reuptake inhibitors or monoamine
oxidase inhibitors.
25. Adverse effectsAdverse effects
Convulsive seizures sometimes observed in
patients receiving parenteral pethidine on a
chronic basis have been attributed to
accumumulation in plasma of the metabolite
norpethidine (normeperidine).
Fatalities have occurred following either
oral or intravenous pethidine overdosage.
"A reassessment of trends in the medical use and abuse of opioid
analgesics and implications for diversion control: 1997-2002". J
Pain Symptom Manage 2004, 28 (2): 176–188. Gilson AM, Ryan
KM, Joranson DE, Dahl JL
26. Meperidine is alive and well in the new millennium: evaluation
of meperidine usage patterns and frequency of adverse drug
reactions. Pharmacotherapy. 2004 Jun;24(6):776-83..Seifert CF,
Kennedy S.
Twenty-five percent of patients who received meperidine had some
degree of renal insufficiency. The average daily dose of meperidine was
230 mg; cumulative doses ranged from 10-7200 mg.
Adverse drug reactions documented in 20 (14%) of 141 patients were
confusion, anxiety, nervousness, hallucinations, twitching, and seizure.
Sixteen of the 20 patients received meperidine by PCA pump or a
combination of PCA and intravenous administration. Patients with ADRs
to meperidine were older (58.5 vs 46.4 yrs, p = 0.004), received more
concomitant benzodiazepines (65.0% vs 4.1%, p < 0.0001), and had a
longer hospital stay (median 9.5 vs 4.6 days, p < 0.001) than those who
did not experience an ADR.
28. Opioid Ideal untuk BalancedOpioid Ideal untuk Balanced
AnesthesiaAnesthesia– Mengurangi nyeri & rasa cemas selama operasi
– Mengurangi respon somatis dan otonom karena
adanya gangguan jalan nafas
– Meningkatkan stabilisasi hemodinamik yang
disebabkan oleh rangsang nyeri (intra-operative
analgesia);
– Mengurangi kebutuhan inhalasi anesthesia
(mengurangi biaya)
– Menghasilkan efek analgesia pasca bedah dengan ES
minimal
29. Drug By Anesthesiologist By Patient
Sufentanil 100% 100%
Fentanyl 100% 94%
Morfin 90% 90%
Petidine 56%* 100%
Flacke J, et al. Comparison of Morphine, Meperidine, Fentanyl, and Sufentanil in Balanced Anesthesia: A Double-Blind Study. Anesth
Analg. 1985;64:897-910
Rendahnya tingkat kepuasan dokter anesthesi pada petidine
disebabkan oleh tingginya angka kejadian ES takikardi
(31%)
100% Dokter Anesthesi menyatakan puas terhadap
kinerja Fentanyl & Sufenta saat melakukan induksi
30. Fentanyl secara signifikan lebih berhasil mencegah respon yang
tidak diinginkan terhadap rangsang nyeri dari luka bedah
dibandingkan morfin
**p<0.01
PCEF (Patient Controlled Epidural Fentanyl)
PCIM (Patient Controlled Intravenous Morphine)
Cooper DW, et al. Patient controlled analgesia: epidural fentanyl and i.v.
morphine compared after caesarean section. British Journal of
Anersthesia. 1999, 82(3):388-370.
Fentanyl : mencegah respon yang tidak diinginkan
terhadap rangsang nyeri dari luka bedah
31. *P<0.05, ***P<0.001
PCEF (Patient Controlled Epidural Fentanyl)
PCIM (Patient Controlled Intravenous Morphine)
Cooper DW, et al. Patient controlled analgesia: epidural fentanyl and
i.v. morphine compared after caesarean section. British Journal of
Anersthesia. 1999, 82(3):388-370.
Fentanyl secara signifikan lebih berhasil mencegah respon yang
tidak diinginkan terhadap rangsang nyeri dari luka bedah
dibandingkan morfin
2.2. Efikasi Fentanyl pada Balanced Anesthesia
dibandingkan dengan Opioid lainFentanyl lebih baik memberikan efek analgesik paska
bedah dibandingkan morfin
35. 15 Cases of Severe Respiratory Depression15 Cases of Severe Respiratory Depression
in 12,000 PCA Patientsin 12,000 PCA Patients
– incorrect prescription: 3 cases
– relative using button: 3 cases
– obstructive sleep apnea: 2 cases
– low level of consciousness: 2 cases
– patient after discharge PACU: 1 case
– technical problem with pump: 2 cases
– young males high use: 2 cases
Audit Data, Acute Pain Service, Auckland Hospital
36. Systemic Opioid
Administration
Conclusions:
• PCA alone is the safest way to administer
systemic opioids.
• Addition of background infusion decreases
safety, but does not increase benefit.
• Human error is the most common cause for
disaster.
• Patient only is permitted to push button.
37. The Chance for Anaesthesiology
“The Departments of Anaesthesiology now
have a golden opportunity to expand their
services into a field where we easily can get
many satisfied customers, something very
different from the operating room or the
intensive care unit, where our patients are
asleep or too sick to appreciate our efforts.”
(Breivik. Pain Digest 1993;3:27)
Editor's Notes
The efficacy of patient-controlled analgesia (PCA) is based on the assumption that postoperative pain control is better with self-administration of opioids using small, repetitive on-demand, intravenous doses, than it is with timed around-the-clock intramuscular (IM) injections. PCA is believed to be more effective than IM administration because blood concentrations of opioid remain fairly constant, as in this figure. The analgesic effect is presumed to be constant as well, though this is not proven.1
1. Ferrante FM, Orav EJ, Rocco AG, Gallo J. A statistical model for pain in patient-controlled analgesia and conventional intramuscular opioid regimens. Anesth Analg. 1988;67:457-61.
At four events, patients given isoflurane anesthesia had
mean arterial pressure (MAP) values that were significantly (P &lt;0.05, α = 5%, β = 10%,δ= 13 mm Hg) lower than awake baseline
values as illustrated with the asterisk (*). CPB=Cardiopulmonary bypass
Visual Analog Scores (VAS) for pain at rest (median interquartile range) for group PCEF (Patient Controlled Epidural Fentanyl) and group PCEF (Patient Controlled Intravenous Morphine). **p&lt;0.01 (Mann Whitney)
Visual Analogue Scores (VAS) for pain on coughing (median interquartile range) for group PCEF and group PCIM. *P&lt;0.05, ***P&lt;0.001 (Mann Whitney)
Pada slide ini memperlihatkan mengenai safety profile dari fentanyl, penelitian ini dilakukan oleh untuk melihat opioid yang aman digunakan bagi pasien dengan gangguan fungsi hati, dan jika dilihat dari tabel ini bahwa Fentanyl yang lebih aman digunakan bagi pasien dengan gangguan fungsi hati, sedangkan Morfin dalam penggunaan harus hati-hati dan harus dimonitor selama penggunaan.