WordPress.com
Introduction to ED Airway Drugs
The following doses on Intubation Drugs in ED are to serve as a guide only and clinical experience is needed for exact dose titration
[pic]
Thiopentone
|Type of Drug |Barbiturate – ultra-short acting |
|Indication |Induction of General Anaesthesia |
|Mode of Action |Inhibits GABA receptors in CNS. Causes hypnotic & sedative effects & has anticonvulsant properties. |
| |No analgesic properties. |
|Dose |2-5mg/kg as IV bolus NB: in ED RSI – lower dose range 0.5-3mg/kg is SAFER |
|Ampoule |500mg powder, made up with 20mL water. |
| |Standard dilution = 25mg/mL |
|Pharmocokinetics notes |Time to effect one arm-brain-circulation time. Fast onset action due to high cerebral blood flow and highly |
| |lipid soluble. |
| |Duration of action 5-15mins. Off-set of action due to re-distribution to other tissues (muscle, then fat), |
| |metabolism by liver. |
|EFFECTS by Systems: |
|CVS |Negative inotropy |
| |↓ cardiac output by 20% |
| |↓ SVR |
| |Resulting ↓ BP |
| |HR can ↑ as compensation |
|Resp |Potent respiratory depressant |
| |Can cause bronchospasm |
|CNS |↓ CBF |
| |↓ ICP |
| |Anticonvulsant activity |
|Other |Post-op nausea & vomiting prominent. |
|Special Points |Tissue necrosis if extravasation occurs. |
| |Can precipitate with neuromuscular blockers – ensure flushed well between administration . |
| |Section 29 drug. |
| |Is traditional drug for RSI & is still drug of choice for RSI in AED. In theatres – trend to use propofol |
| |instead for RSI. |
PROPOFOL
|Type of Drug |Phenol derivative (not expected to remember!) |
|Indication |Induction of General Anaesthetic. |
| |Agent for procedural sedation. |
| |Sedation post intubation |
|Mode of Action |Unclear mode |
|Dose |0.5-2.5mg/kg as IV bolus for induction |
| |For sedation post intubation – infusion of 10mL/hr (ie: 100mg/hr) upwards, “standard” dose|
| |is 20mL/hr |
|Ampoule |200mg in 20mL ampoule in white oil-in-water emulsion. |
| |Concentration = 10mg/mL |
|Pharmocokinetics notes |LOC occurs in approx. 30secs. |
| |Highly protein bound. Waking in 10 minutes. |
| |Metabolism by liver. |
|EFFECTS by Systems: |
|CVS |↓CO |
| |↓BP |
| |↓ SVP |
| |No change in HR |
|Resp |Dose –dependent reduction in ventilation. |
| |Apnoea after bolus induction. |
|CNS |Smooth induction. |
| |Smooth awakening without CNS effects |
|Other |Antiemetic properties |
| |Involuntary movements can occur but are not epileptiform on EEGs |
|Special Points |Painful to injection |
| |No analgesic properties. |
| |Contains purified egg lecithin (yolk component) & soya bean oil. (within anaesthesia |
| |literature – no evidence so far to avoid in pts with egg or soy allergies) |
Etomidate
|Type of Drug |Carboxylated imidazole derivative (not expected to remember!) |
|Indication |Induction of general anaesthesia |
|Mode of Action |Acts on GABA receptors |
|Dose |0.2-0.3mg/kg as IV bolus |
|Ampoule |20mg in 10mL ampoule – in lipid emulsion. |
| |Concentration = 2mg/mL |
|Pharmocokinetics notes |Acts in 10-60 secs, duration of action 6-8 mins |
| |Non-cumulative on repeated dosing as rapidly metabolised by plasma & hepatic esterases |
|EFFECTS by Systems: |
|CVS |Relative cardiovascular stability |
|Resp |Dose –related ↓ RR & Vt |
| |Transient apnoea . coughing / hiccupping can occur |
|CNS |↓ CBF, ICP & cerebral metabolic rate. |
| |Involuntary muscle movements, tremors, hypertonia can occur. |
| |Epileptiform EEGs can occur in 20% pts |
|Other |Potent inhibitor of steroidogenesis – ie: ↓ cortisol & aldosterone for 24hrs post single |
| |dose. |
| |Best to avoid in septic patients |
|Special Points |Pain on injection. |
| |Section 29 drug. |
Ketamine
|Type of Drug |Phencyclidine derivative |
|Indication |Induction of anaesthesia |
| |Procedural sedation |
|Mode of Action |Non-competetive antagonist as NMDA receptor. |
| |May modulate opioid & muscarinic receptors |
|Dose |1-2mg IV bolus over 60seconds |
| |(other routes not discussed here) |
|Ampoule |200mg/2mL ampule. Dilute to 20mL saline |
| |Concentration = 10mg/mL |
|Pharmocokinetics notes |Onset action 30secs, duration 5-10 mins |
|EFFECTS by Systems: | |
|CVS |↑ HR |
| |↑ BP |
| |↑ CO |
| |↑ sympathetic tone |
|Resp |Sli ↑ RR |
| |Airway reflexes preserved |
| |Bronchodilation is a feature |
|CNS |Dissociative anaesthesia |
| |Amnesia |
| |↑ CBR |
| |↑ cerebral metabolic rate |
| |Emergence delirium, unpleasant dreams & hallucinations - reduced by quiet awakening |
|Other |Post-op nausea & vomiting common |
| |↑ salivation |
|Special Points |In Controlled Drug cupboard. |
| |Increased muscle tone means it’s not as good for reduction of major joint dislocations |
Suxamethonium
|Type of Drug |Depolarising neuromuscular blocker |
|Indication |Rapid & profound paralysis to facilitate intubation |
|Mode of Action |Prolonged depolarisation of skeletal muscles by attachment to post-synaptic membrane. |
| |Depolarised NMJ cannot respond to new acetylcholine |
|Dose |1mg/kg |
|Ampoule |100mg in 2mL plastic ampoule with red writing. Use undiluted. |
| |Kept refrigerated. |
|Pharmocokinetics notes |Onset action 30seconds as evidenced by generalised muscular contractions & fasiculations. |
| |Duration 3-5minutes. |
| |Metabolised by plasma cholinesterases. |
|EFFECTS by Systems: |
|CVS |Bradycardia if repeated doses |
|Resp |Apnoea |
|CNS |↑ ICP |
| |↑ intraocular pressure |
|Other |↑ K levels by 0.4mmol/L |
| |↑ intragastric pressure |
| |↓ lower oesophageal sphincter tone |
|Special Points |Atypical plasma cholinesterases can cause a prolonged blockade of 1-3 hrs. |
| |Potent trigger of malignant hyperthermia. |
| |Hyperkalaemic response is exaggerated ( with potential VF arrest) in |
| |Burns (after 24-48hrs, & can last up to 1-2 yrs) |
| |Denervated skeletal muscles leading to atrophy (eg: post spinal cord injury) from 96 hrs |
| |post denervation |
| |Muscular dystrophy |
| |Severe skeletal muscular trauma |
Rocuronium
|Type of Drug |Non-depolarising neuro-muscular blocker |
|Indication |Paralysis for intubation and control of ventilation. |
| |Used for RSI when suxamethonium is contraindicated |
|Mode of Action |Competitive antagonist of acetylcholine at the post-synaptic membrane of neuromuscular junction. |
|Dose |0.6mg/kg is standard intubating dose - intubate after 60- 90 secs |
| |1mg/kg – intubation in 45 secs ( similar to suxamethonium) |
|Ampoule |Ampoule of 5mL, concentration = 10mg/mL |
|Pharmocokinetics notes |Excreted by hepatic route. |
| | |
| |Duration of action depends on dose used |
| |30-40mins for standard dose |
| |up to 1 hour for higher dose. |
|EFFECTS by Systems: |
|CVS |Nil |
|Resp |Apnoea |
|CNS |Nil |
|Other | |
|Special Points |Use of Rocuronium as a paralysing agent mandates that the pt is easy to ventilate prior to paralysis, |
| |and airway assessment indicates an easy intubation. NEVER use if any doubt exists ! |
| | |
| |There is a reversal agent (Sugammadex) that provides rapid reversal of Rocuronium– but at the profound |
| |blockage stage post RSI, onset of action can still be up to 6-7 minutes - long enough that hypoxic |
| |brain injury would occur if you can’t oxygenate. It is NOT available in AED. |
| | |
| |Precipitates with thiopentone. |
| |Safe in patients with malignant hyperthermia. |
Metaraminol
|Type of Drug |Synthetic sympathomimetic |
|Indication |Management of hypotension |
|Mode of Action |Direct * & Indirect # sympathomimetic agonist. |
| |Acts predominantly at alpha adrenoreceptors |
|Dose |0.5mg – 1mg boluses , titrating to effect |
|Ampoule |10mg/mL ampoule. Dilute into 20mL syringe with saline |
| |Concentration = 0.5mg/mL |
|Pharmocokinetics notes |Onset 1-2mins. |
| |Maximum effect at 10mins |
|EFFECTS by Systems: |
|CVS |↑ SBP |
| |↑ DBP |
| |Reflex ↓ HR occurs |
| |Positive inotropy |
|Resp | |
|CNS |↓ CBF |
|Other | |
|Special Points | |
| | |
|Direct * |Binds at receptor to activate it directly |
|Indirect# |Binds at postganglionic sympathetic nerve endings to cause release of neurotransmitter |
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- wordpress passing data between pages
- wordpress business templates
- wordpress rss feed not working
- wordpress jquery is not defined
- create wordpress blog
- wordpress roles editor
- wordpress full rss feed
- wordpress rss feed settings
- wordpress rss feed plugin
- wordpress display rss feed
- wordpress rss feed link
- wordpress rss feed to post