TAILIEUCHUNG - EMERGENCY SEDATION AND PAIN MANAGEMENT - PART 10

An thần khẩn cấp về thủ tục và hiệu ứng ionotropic giảm đau giới hạn sử dụng của nó trong multitrauma bệnh nhân và các tình huống lâm sàng khác thường liên kết với sự bất ổn định huyết động học. Ketamine là một phái sinh phenylcycline. | 264 Special Considerations for Emergency Procedural Sedation and Analgesia central venous return and decreases in both intracerebral blood flow and intracerebral pressure. These systemic effects are exacerbated in hypovolemic distributive shock patients. Benzodiazepines bind to benzodiazepine receptors enhancing GABA effects. Similar to barbiturates benzodiazepines are negative inotropes with sedative hypnotic properties and no analgesic effect. They are useful adjuvants for induction of intubation and are often combined with opioids during RSI. Benzodiazepines are lipophilic. This is particularly true of midazolam which has become the most commonly used benzodiazepine for induction. Midazolam is not a tissue irritant and can be given via intramuscular administration. Benzodiazepines potentiate respiratory depression and hypotension effects when used in combination with opioids. Benzodiazepines produce amnesia are anxiolytic and are potent muscle relaxants. They have the unique advantage compared to other induction agents of being reversible with flunazemil. Opioids specifically Fentanyl may also be useful for anesthesia induction in addition to premedication. A large dose of fentanyl is used for induction ranging from 3 to 25 mcg kg depending on the adjuvant medications used and the rate of infusion. Hypotension and respiratory depression are associated with fentanyl use in this setting. Chest wall rigidity has been associated with rapidly infused fentanyl at high doses. Opioids also have the advantage of being reversible with naloxone. Propofol is an alkylphenol with an unknown mechanism of action. Propofol is believed to have an interaction with GABA receptors resulting in effects as a sedative hypnotic with no analgesic effect. Propofol produces amnesia similar to benzodiazepines. Similar to barbiturates propofol is a myocardial and respiratory depressant that causes hypotension by a reduction in systemic vascular resistance and negative inotropy. Fluid boluses

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