Dexmedetomidine Case Study
RESPIRATORY EFFECTS Dexmedetomidine is able to achieve its sedative, hypnotic and analgesic effects without causing any clinically relevant respiratory depression unlike opioids. The changes in ventilation appeared similar to those observed during natural sleep. Dexmedetomidine do not cause any changes in arterial oxygenation, pH and respiratory rate.(67) It also exhibited a hypercarbic arousal phenomenon, which has been described during normal sleep and is a safety feature. The obstructive respiratory pattern and irregular breathing seen with high doses of 1-2µg/kg given over 2 minutes and are probably related more to deep sedation and anatomical features of the patient and this could be easily overcome by insertion of an oral airway.(72) …show more content…
Use of dexmedetomidine for regional anaesthesia a. Epidural dexmedetomidine at a dose of 100µg decreased the incidence of postoperative shivering.(87) b. Intrathecal dexmedetomidine at a dose of 3µg causes significant prolongation of sensory and motor blockade.(88) c. Addition of 0.5µg/kg body weight of dexmedetomidine to lidocaine for intravenous regional anaesthesia improves the quality of anaesthesia and perioperative analgesia.(89) 3. Use in monitored anaesthesia care (MAC): Dexmedetomidine confers arousable sedation with ease of orientation, anxiolysis, mild analgesia without respiratory depression.(90) 4. Dexmedetomidine has also been used as sole anaesthetic agent upto doses of 10µg/kg/hr.(75) 5. Use of dexmedetomidine in postoperative period: infusion can be continued in extubated and spontaneously breathing patients. The ongoing sedation and sympatholytic effect is beneficial in reducing postoperative myocardial ischemic events in high risk patients undergoing non-cardiac surgery.(90) 6. Use of dexmedetomidine in paediatric age group:(91) addition of dexmedetomidine 2µg/kg body weight to bupivacaine for caudal analgesia promotes analgesia after anaesthetic recovery without increasing the incidence of side …show more content…
The maintenance dose is titrated until the sedation goal is reached. It is not necessary to discontinue Dexmedetomidine before, during or after extubation. Dose up to 2.5µg/kg/hr for up to seven days, with no rebound effect on withdrawal and no compromise in haemodynamics stability have been used in clinical trials.(95) Drug interactions Dexmedetomidine has shown to inhibit CYP2 D6 in vitro, but the clinical significance of this inhibition is not well established. Dexmedetomidine appears to have little potential for interactions with drugs metabolized by the cytochrome p450 system. Co-administration of Dexmedetomidine with sevoflurane, isoflurane, propofol, alfentanil and midazolam may result in enhancement of sedative, hypnotic or anaesthetic
Scope Of Practice Case Study
262 Words | 2 PagesScope of Practice: Overall, Dr. Jaen’s main responsibility is to administer anesthesia to patients before surgery. Surgery includes a wide variety of procedures. Anesthesiologists even administer anesthesia to young children and neonatal patients prior to diagnostic tests such as MRIs. For intensive care patients, anesthesiologists are often responsible for ventilator and airway control. In addition, anesthesiologists have the authority to prescribe drugs to patients.
Kelly Malone Case Summary
242 Words | 1 PagesJustin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.
Wannabe Treatment Plan
1174 Words | 5 PagesPerform a 12-lead electrocardiogram (ECG) as prescribed. We do ECG once a day routinely and a cardiac rhythm strip as needed. Besides providing information on dysrhythmias, the ECG may document post-operative myocardial ischemia that may also affect cardiac output. Amiodarone 200mg tds were given in treating atrial fibrillation. Beta blocker (Metoprolol 47.5 m OD) were given to slow the heart rate and control his blood
HPC Code Of Ethics: What Is Sibert´s Anaesthetic Phase?
1831 Words | 8 PagesWhen Sibert was not responding the anaesthetist then allowed a slow inhalation of Isoflurane to be delivered to patient through the face mask. When the patient was fully anaesthetised the author assisted the anaesthetist to secure the airway by passing size 4 Laryngoscope and size 8 endotracheal tube (ETT). The ETT was cuffed and tightly secured. Sibert was then transferred to the operating table and monitoring continued. Anaesthesia was maintained with O2, Isoflurane, and N2O on spontaneous ventilation with closed circuit.
Medication: A Case Study
1024 Words | 5 PagesMedication: Tylenol #3 1-2 tabs PO q4h PO prn Docusate 100 mg PO BID prn Rationale: Received 400mg ibuprofen 3 hours ago and her current level of pain is 7/10. I am choosing to give her Tylenol #3 to control the intense pain she is experiencing from the episiotomy and third-degree laceration and intense labour. This medication is appropriate because she reported experiencing a lot of pain since delivery. The length of time that is appropriate for her to take this medication is solely based upon continuous assessments of her pain between doses. Continuous pain assessment will determine how long she will take this medication as a major concern is the crossing over of codeine, acetaminophen and caffeine into the breast milk (Chow, 2013).
Rapid Consequence Intubation (RSI)
644 Words | 3 PagesEtomidate is a short acting sedative that avoids affecting respiratory, cardiac and circulation centers, meaning less adverse reaction in the patient (Mason et al., 2013). Midazolam is a benzodiazepine sedative that can be used in RSI, but tends to cause hypotension in patients (Mason et al., 2013). Ketamine is another sedative that can be used, but it is usually a third choice after etomidate or midazolam because of its adverse affects (Mason et al., 2013). Propofol is the final sedative or hypnotic that is used in RSI, it has adverse effects including hypotension, and because of its short acting period is used primarily in conscious sedation procedures and not RSI (Mason et al.,
Antagonistic Effects Of Methadone
136 Words | 1 PagesMethadone exists as two enantiomeric forms, R and S (Eap et al., 2002). The most commonly used form of methadone in maintenance treatment is the racemic mixture (RS- methadone) (Groman et al., 1997). It is the R-isoform that gives most of the opioid effects (Eap et al., 2002). Methadone exerts its analgesic and narcotic effects through the µ-OR subtype, and has antagonistic effect at the NMDA receptor (Trescot et al., 2008). The antagonistic effect at the NMDA receptor is believed to be advantageous in preventing induction of tolerance (Callahan et al., 2004).
Art Austin Case Summary
1210 Words | 5 PagesArt suffered form insomnia and was prescribed Trazodone by his doctor (Surviving Trauma and Tragedy, 2007). I will conduct an appropriate diagnosis, rule out disorders, assist Art in reducing stress,
Opioid Case Study
1301 Words | 6 PagesI. Inadequate Monitoring of Opioid-Induced Respiratory Depression Opioids are a category of pain medications that reduce the stimulus of pain signals sent from the brain. Within this category are medications such as hydrocodone, oxycodone, morphine, codeine, and other similar drugs. These medications are used to treat mild to severe pain depending on dosages and type of opioid given. With the reduced perception of pain also comes a plethora of unpleasant symptoms such as drowsiness, mental confusion, nausea, constipation, and, depending upon the amount of drug taken, can depress respiration. However, many experience a euphoric experience after administration that drives them to abuse opioids.
Patients Informed Consent
515 Words | 3 PagesPatients evaluated in acute pain will often have narcotics withheld until after the patient has been evaluated by a surgeon and has given informed consent. Concern that the patient would have impaired judgment due to narcotic effects often prevents the administration of timely pain relief. Similarly administration of anxiolytics and benzodiazepines are avoided until the patient has consented to the procedure. As there is a considerable heterogeneity in the metabolism of a particular drug depending on age and patient characteristics, there is no specific timeline of how long should one wait prior to getting consent if these medications are given accidentally.
Dyssynchrony Case Summary
1209 Words | 5 PagesMr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning. The problems that are to be manage include, being on the ventilator, being sedated, having an elevated temperature, having a low hemoglobin, post surgical bowel resection, splenectomy, hypoxia and diet intolerance.
Awake Extubation Case Study
717 Words | 3 PagesThe anaesthetist removed the ETT and proceeded to place a tight fitted mask on patients face. (REF)She then alerted the team that there was a problem with the patient airway (REF). The mask did not mist up – indicating of no air movement return, there was no carbon dioxide trace on the capnography and the patient oxygen saturation dropped steadily from 100% to 90%. He instigated vigorous jaw thrust to improve oxygenation, and using continuous positive airway pressure(CPAP) to deliver 100% oxygen flow through the breathing bag attached to the anaesthetic machine but all this effort was not having any effect on the ventilation. He then asked my mentor the Operating Department Practitioner (ODP) to administer 50mg/5ml of intravenous Propofol.
Anesthesiologist Essay
399 Words | 2 PagesAnesthesiologists are medical doctors who keep a patient comfortable, safe and pain-free during surgery by administering local or general anesthetic. Once the patient enters the operating room, an anesthesiologist will be by their side throughout the entire surgery, making sure they are stable right through to the post- anesthesia care unit. Anesthesiology is a renowned and remunerative field of medicine, but requires an abundance of education and expertise (“Anesthesiologist”). Anesthesiologists do many things which all require a substantial amount intelligence. Before surgery an anesthesiologist will meet with the patient prior to the surgery to make sure that they are suitably prepared as well as medically fit to endure the proposed surgery
Simplified Organ Failure Assessment
252 Words | 2 PagesDiagnosing a patient 's illness state is always a critical phase in medication. Patients admitted in the Intensive Care Unit are vulnerable to adverse effects including in-ICU morbidities and mortality. Patients in ICU are connected to equipments like Pulse oximeter, Cardiac Monitor, Face mask, Nasogastric tube to monitor their oxygen level in blood, heart rate, blood pressure and support their breathe. They are closely monitored by Cardiothoracic nurses who records these readings from the equipments several times a day. Presently, health care researchers are more focused on developing techniques to improve the effectiveness of the treatment.
Effective Perioperative Management Essay
975 Words | 4 PagesEffective perioperative management of medications requires an understanding of the patient and his or her co morbidities so that the risk of perioperative decompensation can be gauged. This understanding stems from a thorough medical history that includes a comprehensive medication history to provide a complete inventory of the all prescription medications, all over-the-counter agents and all herbal medications. Out of 288 cases collected, 88% were in the age group of 41-80 years. Hypertension and diabetes combination was found to be the comorbities in majority of cases. In most of the cases medication use during perioperative settings was as per available literature indicating appropriate medication reconciliation in the hospital settings.
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