sedationandanalgesiainthepicu[鎮(zhèn)靜鎮(zhèn)痛在picu](ppt-41)-資料下載頁
2025-01-12 08:43本頁面
【正文】 meds. UTHSCSA Pediatric Resident Curriculum for the PICU MAJOR TRANQUILIZERS ? Phenothiazine – Thorazine ? Butyrophenones – Droperidol – Haloperidol ? Common in adult ICU, unmon in PICU ? Side effects hypotension due to alpha blockade and extrapyramidal effects ? At times useful in the difficult to sedate child UTHSCSA Pediatric Resident Curriculum for the PICU 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 bloodbrain barrier, 30 seconds UTHSCSA Pediatric Resident Curriculum for the PICU KETAMINE ? Redistribution halflife minutes ? Elimination halflife 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 hemodynamic effect – Negative inotrope – Central effect ?HR, ?SVR ? Good choice in shock or status asthmaticus UTHSCSA Pediatric Resident Curriculum for the PICU 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 UTHSCSA Pediatric Resident Curriculum for the PICU PROPOFOL ? Sedative/hypnotic – Dose dependent conscious sedation to general anesthesia – Rapid onset (2050 seconds) – Quick recovery ( within 30 minutes of d/c) – Lack of active metabolites – Metabolized in liver – Excreted in urine UTHSCSA Pediatric Resident Curriculum for the PICU 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 – mg/kg UTHSCSA Pediatric Resident Curriculum for the PICU 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 510 mcg/kg/min increments of 5 10 minutes
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