sedationandanalgesiainthepicu[鎮(zhèn)靜鎮(zhèn)痛在picu](ppt-41)(編輯修改稿)
2025-02-08 08:43 本頁面
【文章內(nèi)容簡介】 lected intervals ? Improved analgesia with decreased narcotic use ? Option to include low basal rate ? Nurse controlled analgesia – Eliminates delay – Allows delivery via a closed system UTHSCSA Pediatric Resident Curriculum for the PICU PCA UTHSCSA Pediatric Resident Curriculum for the PICU OPIATE SIDE EFFECTS ? RESPIRATORY DEPRESSION – Reversal Nalaxone (Narcan) ? Full reversal 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 UTHSCSA Pediatric Resident Curriculum for the PICU 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 23 days of frequent/continuous use – Greater with fentanyl – Treated by increasing the dose as needed UTHSCSA Pediatric Resident Curriculum for the PICU OPIATE SIDE EFFECTS ? DEPENDENCE – Physiological state leading to abstinence syndrome on withdrawal of the drug – Generally develops after 710 days of sustained use – Symptoms include: mydriasis, tachycardia, goose bumps, muscle jerks, vomiting, diarrhea, seizures, fever, hypertension – Treated with gradual withdrawal of the drug UTHSCSA Pediatric Resident Curriculum for the PICU 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 UTHSCSA Pediatric Resident Curriculum for the PICU 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) UTHSCSA Pediatric Resident Curriculum for the PICU DIAZEPAM (VALIUM) ? Sedating, variable amnesia, anxiolytic ? Irritating to veins, pain in PIV ? Multiple active metabolites – Advantage for prolonged sedation – Disadvantage for rapid arousal – Not remended for continuous infusion ? Halflife 1224 hrs ? Hepatic metabolism UTHSCSA Pediatric Resident Curriculum for
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