This document outlines goals, definitions, challenges, monitoring, and medication options for sedation and analgesia in the pediatric intensive care unit (PICU). The goals of PICU sedation include patient comfort, pain control, anxiolysis, amnesia, and facilitating procedures. Common drugs utilized are opioids, benzodiazepines, chloral hydrate, barbiturates, ketamine, propofol, and neuroleptics. The document reviews dosing, administration, benefits, side effects and precautions for each class of medication.
Principles and Practice of Sedation in Intensive Care Unit (ICU)Apollo Hospitals
Distress is common amongst critically ill patients in ICU, especially those who are intubated or have difficulty communicating with their caregivers [1]. Distress in ICU generally presents as agitation. It needs to be treated for patient comfort & if left untreated increases sympathetic tone with untoward physiologic effects [2].
Before a sedative agent is initiated to manage agitation, the cause of distress should be identified & treated. Common causes of distress in critically ill patients include:-anxiety, pain, delirium, dyspnoea and neuromuscular paralysis. These etiologies may occur separately or in combination.
Principles and Practice of Sedation in Intensive Care Unit (ICU)Apollo Hospitals
Distress is common amongst critically ill patients in ICU, especially those who are intubated or have difficulty communicating with their caregivers [1]. Distress in ICU generally presents as agitation. It needs to be treated for patient comfort & if left untreated increases sympathetic tone with untoward physiologic effects [2].
Before a sedative agent is initiated to manage agitation, the cause of distress should be identified & treated. Common causes of distress in critically ill patients include:-anxiety, pain, delirium, dyspnoea and neuromuscular paralysis. These etiologies may occur separately or in combination.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
Reactive airway obstruction in children detection management_2018_pmmParthiv Mehta
Airways are too sensitive in children. Its reactivity may be incidental or occasional. if that remains repetitive, it becomes a concern for child, family and treating team. Addressing here spectrum of Reactive Airway Obstruction in Children from a Pulmonologist's view
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
This presentation is about Surfactant, its use in Respiratory Distress Syndrome & some other conditions of surfactant deficiency due to inactivation like meconium aspiration syndrome & others
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
Mechanical Ventilation and RAD - Prof. K. Chellum Oration / CMC Vellore 26th ...Creativity Please
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
Reactive airway obstruction in children detection management_2018_pmmParthiv Mehta
Airways are too sensitive in children. Its reactivity may be incidental or occasional. if that remains repetitive, it becomes a concern for child, family and treating team. Addressing here spectrum of Reactive Airway Obstruction in Children from a Pulmonologist's view
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
This presentation is about Surfactant, its use in Respiratory Distress Syndrome & some other conditions of surfactant deficiency due to inactivation like meconium aspiration syndrome & others
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
Mechanical Ventilation and RAD - Prof. K. Chellum Oration / CMC Vellore 26th ...Creativity Please
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
Presentation on In and out of potassium by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
RAN Chemicals - Products Paper - R-BLK-3260 – BULK IMPROVERCreativity Please
New generation polyester polymeric compound applicable for paper industries especially for writing-printing and news prints, to enhance the bulkiness of the paper Improves the bulk of the paper.
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Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Introduction TO VOMITING,Pathophysiology of vomiting,Emetics,Anti emetics,classification,pharmacology,Drug treatment in selected circumstances FOR EMETICS were included.
this is all medicine are used in anesthesia so as student are in field of anesthesia you can find this attachment, may it will help you to know more about this general anesthetics drugs if you got a questions you contact me inbox
Corporate Presentation of Kinetic Gears which was established in 1980 as SSI Unit, Kinetic Gears is an ISO 9001:2015 certified organisation since 1999 & at present it’s a family-owned business. The unit is an approved supplier in Automobile, Textiles, Coal, Steel, Power, Defense & Aviation Sector.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Corporate Presentation of Kinetic Gears which was established in 1980 as SSI Unit, Kinetic Gears is an ISO 9001:2015 certified organisation since 1999 & at present it’s a family-owned business. The unit is an approved supplier in Automobile, Textiles, Coal, Steel, Power, Defense & Aviation Sector.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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3. GOALS
Patient comfort
Control of pain
Anxiolysis
Amnesia
Blunting adverse autonomic and hemodynamic
responses
Facilitate nursing management
Facilitate mechanical ventilation
Avoid self-extubation or self injury
Reduce oxygen consumption
4. SEDATION and ANALGESIA
Inadequate analgesia and postsurgical
stress response is a metabolic, humoral,
and hemodynamic response following
injury or surgery
This neuroendocrine cascade leads to
increased oxygen consumption,
increased carbon dioxide production,
and a generalized catabolic state with a
negative nitrogen balance
5. SEDATION/ANALGESIA
Sedation (seda/shun) [L. sedatio, to calm, allay].
The act of calming, especially by the
administration of a sedative, or the state of being
calm.
Analgesia (an-al-je/zi-ah) [G. insensibility, from an -
privative,negative + algesis, sensation of pain] A
condition in which nocioceptive stimuli are
perceived but are not interpreted as pain; usually
accompanied by sedation without loss of
consciousness.
6. IDEAL PICU
SEDATIVE/ANALGESIA
Rapid onset
Predictable duration
No active metabolites
Rapid recovery
Multiple routes of delivery
Easy to titrate
Minimal cardiopulmonary effects
Not altered by renal or hepatic disease
No drug interactions
Antidote available
Wide therapeutic index
31. OPIOIDS
First line drugs
Provide analgesia and sedation, NOT amnesia
Act similarly as a class
Produce delayed gastric emptying, decreased
intestinal peristalsis, and urinary retention
Narcotic to be used:
Morphine
Fentanyl
Methadone
32. OPIOIDS
ROUTE OF ADMINISTRATION
IV
Oral
Transmucosal
Transdermal
MODE OF ADMINISTRATION
Intermittent/on demand (as necessary)
Fixed interval
Continuous infusion
PCA
33. MORPHINE
Gold standard
Hepatic metabolism
Depresses respiration by altering
chemoreceptor sensitivity to CO2
Depresses rate over tidal volume
Decreases sigh frequency
Can cause hypotension due to histamine
mediated vasodilation
Can block compensatory catecholamine
effect
Prolonged clearance in neonates
35. FENTANYL
Synthetic opiate, 100 x more potent than
morphine
Rapid onset, highly lipophilic, rapidly crosses
BBB, redistributed to fatty tissue
Short distribution t1/2, long elimination t1/2
Minimal hemodynamic effect
Blunts pulmonary vascular responses
May produce “chest wall rigidity”, reversed with
relaxants or naloxone
36. FENTANYL
IV intermittent dosing
1-2 mcg/kg q 1-2 hrs
IV continuous dosing
1-2 mcg/kg/hr
Transdermal delivery system available
Not recommended in children less than 12
yrs
25,50,75,100 mcg/hr
25 mcg/hr is equivalent to 15 mg morphine
in a 24 hr period
37. METHADONE
Equipotent to morphine
Minimal hemodynamic effects
Long half life
Sedation and euphoric properties less
pronounced than morphine
Useful for pain control and abstinence PO dosing
0.1 mg/kg q 4-8 hrs
50 % oral bioavailability
Drug accumulation with repeated doses
caused by extensive protein binding
38. MODE OF ADMINISTRATION
Intravenous bolus administration
Common
PRN - as needed
Half-life of drug determines interval
Disadvantage of pain breakthrough
40. CONTINUOUS INFUSION
Utilized when prolonged analgesia and
sedation needed
Less labor intensive
Better analgesia, initial bolus important
Need for dedicated IV site
42. PCA
Patient controlled analgesia
Allows patient to administer a preset amount of
narcotic at preselected intervals
Improved analgesia with decreased narcotic use
Option to include low basal rate
Nurse controlled analgesia
Eliminates delay
Allows delivery via a closed system
44. OPIATE SIDE EFFECTS
RESPIRATORY DEPRESSION
Reversal - Nalaxone (Narcan)
Full reversal 0.1 mg/kg
Partial reversal - titrate to effect
Half life is less than narcotics
IV,IM,Sub Q, ETT
Abrupt reversal may result in nausea,
vomiting, sweating, tachycardia, increased
BP, and tremors
45. OPIATE SIDE EFFECTS
Pruritis
Individual variability and susceptibility,
alleviated by Benadryl
Tolerance
Need for increase in dose to achieve the
same effect
Generally develops after 2-3 days of
frequent/continuous use
Greater with fentanyl
Treated by increasing the dose as needed
46. OPIATE SIDE EFFECTS
DEPENDENCE
Physiological state leading to abstinence
syndrome on withdrawal of the drug
Generally develops after 7-10 days of
sustained use
Symptoms include: mydriasis, tachycardia,
goose bumps, muscle jerks, vomiting, diarrhea,
seizures, fever, hypertension
Treated with gradual withdrawal of the drug
47. OPIATE SIDE EFFECTS
DEPENDENCE
In general the longer the period of treatment the
longer the period of withdrawal needed
A child is at risk for dependence if they have been on
narcotics for a week
Finnegan scoring to monitor adequate weaning dose
Weaning strategies can vary, typically 10% decrease
per day
Do not spread the dosing interval beyond the
normal dosing interval, rather decrease the dose
Can substitute methadone and wean q 48 hrs over
a longer time period
48. BENZODIAZEPINES
First line agents for sedation
Provide hypnosis, anxiolysis, antegrade amnesia,
and anticonvulsant activity
NO ANALGESIA
Can cause abstinence syndrome after prolonged
use
Mechanism in the limbic system via the inhibitory
neurotransmitter, gamma aminobutyric acid
(GABA)
49. DIAZEPAM (VALIUM)
Sedating, variable amnesia, anxiolytic
Irritating to veins, pain in PIV
Multiple active metabolites
Advantage for prolonged sedation
Disadvantage for rapid arousal
Not recommended for continuous infusion
Half-life 12-24 hrs
Hepatic metabolism
50. LORAZEPAM (ATIVAN)
Improved amnesia
No active metabolites
Half life 4-12 hours
Metabolized by glucuronyl transferase
Less influence from other drugs
Better preserved in patients with liver
disease
51. MIDAZOLAM (VERSED)
Rapid onset
Rapid metabolism
Good amnesia
Water soluble, no pain
with injection
Half life 2 -4 hours
Hepatic metabolism with
renal excretion
Active hydroxy-
metabolite may
accumulate
Other routes of
administration
Oral
Nasal
Rectal
Sublingual
Less absorption requiring
increase dosing
52. MIDAZOLAM
Reports of dystonia and choreoathetosis
post infusion, greater risk in neonates
Heparin decreases protein binding,
increases free drug
Disadvantage cost
20 kg patient
80 $/day compared to Ativan = 30 $/day
53. BENZODIAZEPINES
SIDE EFFECTS
RESPIRATORY DEPRESSION
Less than narcotics, but potentiated with
narcotics
Dose related
Reversal
Flumazenil - benzodiazepine receptor antagonist
Contraindicated in patients with chronic benzo use
for seizures, mixed overdose, TCA’s - may result in
seizures
54. BENZODIAZEPINES
SIDE EFFECTS
Choreoathetoid movement disorder
Tolerance
As with narcotics may need to increase dose
following 2-3 days use
Dependence
Withdrawal carefully and slowly if on greater
than 7-10 days
Signs of withdrawal - tremor, tachycardia,
hypertension,
Rapid withdrawal may promote seizures
55. CHLORAL HYDRATE
Sedative hypnotic agent
Metabolized in the liver to its active form,
trichlorethanol
Half life 8-12 hours
Oral or rectal administration
Onset of action delayed
Paradoxical reaction in some older children
Not to exceed 100 mg/kg/day - i.e.: 25mg/kg/q 6 hrs
Caution in children < 3 months or with hepatic
dysfunction
57. BARBITURATES
Useful in patients with increased ICP
Short acting barbiturate useful for
sedation for procedure/imaging in
hemodynamically stable child
Alkaline solution, often incompatible with
TPN or meds.
58. MAJOR TRANQUILIZERS
Phenothiazine
Thorazine
Butyrophenones
Droperidol
Haloperidol
Common in adult ICU, uncommon in PICU
Side effects hypotension due to alpha blockade
and extrapyramidal effects
At times useful in the difficult to sedate child
59. KETAMINE
Dissociative IV anesthetic
Good amnesia and somatic analgesia
Anesthetic state classically described as a functional
and electrophysiological dissociation between the
thalamoneocortical and limbic system
Chemically related to phencyclidine and
cyclohexamine
Water and lipid soluble
Quickly crosses blood-brain barrier, < 30 seconds
60. KETAMINE
Redistribution half-life 4.7 minutes
Elimination half-life 2.2 hours
Clinical effects evident within one minute, resolution within
15 - 20 minutes of dose
Bronchodilation
Sialagogue -“promoting the flow of saliva”
Administer with an anticholinergic
Atropine or Robinol
Minimal net hemodynamic effect
Negative inotrope
Central effect - HR, SVR
Good choice in shock or status asthmaticus
61. KETAMINE
Risk of laryngospasm
Risk of emesis/aspiration
Increases ICP , globe pressure
Seizure inducing
Emergent reactions, hallucinations
Improved with administration of a benzodiazepine
IM: 2 - 4 mg/kg dose q 30 minutes - 1 hour
IV
Intermittent dosing
1 -2 mg/kg dose q 30 minutes to 1 hr
Continuous dosing
1 - 3 mg/kg/hr
62. PROPOFOL
Sedative/hypnotic
Dose dependent - conscious sedation to
general anesthesia
Rapid onset (20-50 seconds)
Quick recovery ( within 30 minutes of d/c)
Lack of active metabolites
Metabolized in liver
Excreted in urine
63. PROPOFOL
Lipid emulsion, reports of anaphylaxis
Soybean oil, egg lecithin, and glycerol
Decreased ICP, may lower CPP
Decreased sympathetic tone
Contraindicated in hemodynamically
unstable
Moderate respiratory depression
Pain with injection/infusion site
Improved with use of 1% lidocaine
0.5 mg/kg
64. PROPOFOL
Neurologic sequela
Opisthotonic posturing
Myoclonic movements
Metabolic acidosis reported with use > 24 hrs
Contraindicated for long term use
Doses
1 - 3 mg/kg induction
20 - 100 mcg/kg/min
Increase infusion rate 5-10 mcg/kg/min increments
of 5 - 10 minutes