Pharmacology of Opioids
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2021
Opium and its many preparations have been used for the treatment of pain for over 2000 years. Many of its pharmacological effects, such as euphoria and sedation, appear to have been known as far back as at least 3000 bc at the time of the ancient Sumerians and Minoans, and mention is made of its analgesic effect in Egyptian mythology. When switching to the atypical opioids tramadol and tapentadol, the reduced ++-load can induce withdrawal symptoms, if doses are not slowly tapered. Long-term use of buprenorphine seems to result in less tolerance than conventional opioids. However, in the acute pain setting, studies have shown no differences in pain relief or the incidence of adverse effects including nausea and vomiting, OIVI, and sedation compared with conventional opioids. The main advantages over equianalgesic doses of other conventional opioids are less sedation and OIVI and less constipation; the incidence of nausea and vomiting is generally similar.
Sleep, sedation and coma
Ad (Sandy) Macleod, Ian Maddocks in The Psychiatry of Palliative Medicine, 2018
Sleep is a state of ‘suspended consciousness’, a temporary interruption of sensorimotor interaction with the environment. Clinically, the distinguishing feature of sleep, in contrast to coma, is the ease with which the sleeping subject can be roused to awareness of the external world. Between alertness and coma are a variety of altered states of consciousness. Palliative sedation refers to the intentional clinical practice of suppressing consciousness to control refractory symptoms during the last days or hours of life, in a manner that is ethically acceptable to the patient, family and healthcare providers. The intractable symptoms, which have proven non-responsive to all other interventions, are contained by the induction and the continuance of deep sedation. Deep sedation may need to be maintained until death; the duration is usually in the range of 1–6 days. Trial releases of deep sedation can be orchestrated, if required, by withholding the dose or administering flumazenil. The dosage necessary to induce deep sedation is variable.
Pain management and sedation
Chris Carter in Critical Care Nursing in Resource Limited Environments, 2019
A survey of the International Association for the Study of Pain members in low resource settings revealed 91% of members reported limited education was the main barrier to pain management. The perception amongst healthcare professionals can influence pain management strategies; for example, Chan et al. reported while surgeons recognised effective pain management improved recovery, they also found 70% of surgeons felt patients should expect pain post-operatively. Effective pain management in critical care allows endotracheal tube (ETT) tolerance, mechanical ventilation, suctioning and other distressing procedures to be undertaken, co-operation with care, reduce stress response and cause less disturbing memories. Assessing pain in a critically ill patient can be challenging, due to sedation or an ETT preventing communication, resulting in pain often being underassessed and undertreated. Critically ill patients often require continuous infusions of both short-acting analgesia and sedations if ventilated. Examples include: analgesics: morphine or fentanyl and sedations: midazolam or propofol.
Recommendations for good practice for sedation in assisted conception
Published in Human Fertility, 2020
Umesh Acharya, Nick Elkington, Louisa Manning, Daryl Thorp-Jones, Geoff Tavener
Conscious sedation is a commonly used approach to provide pain relief during transvaginal oocyte retrieval. It has been shown to be effective with high levels of acceptability and patient satisfaction. Fundamental Standards and Development Standards in safe sedation practice have been set out by the Royal College of Anaesthetists and they recommend that Royal Colleges, in association with the relevant sub-specialty organizations, should develop guidelines on sedation methods appropriate to clinical practice in their sphere of influence. This Policy and Practice paper outlines the human resources and equipment necessary to optimize patients’ safety for the administration of intravenous (I.V.) sedation in assisted conception units, based on the most current evidence and guidance available.
The Use of Propofol for Continuous Deep Sedation at the End of Life: A Definitive Guide
Published in Journal of Pain & Palliative Care Pharmacotherapy, 2019
The anesthetic propofol is used in a number of medical applications including surgery, procedural sedation, refractory status epilepticus, alcohol withdrawal, and critical care sedation. The manner in which it is dosed and administered in each environment varies, tailored to the specific task at hand. Because the use of propofol in end-of-life care is uncommon, providers may lack practical experience, and resources that are specific to this specialized application are not comprehensive and largely based on dosing and administration as it is done on the intensive care unit. The purpose of this review is to provide an evidence and experienced based reference for the specific use of propofol for end of life sedation.
Dexmedetomidine sedation in a child with frontonasal encephalocoele scheduled for MRI
Published in Egyptian Journal of Anaesthesia, 2014
Mamta Bhardwaj, Kiranpreet Kaur, Asthana Unnati, Kirti Khetrapal, Savita Saini
Paediatric patients undergoing radiological imaging often require sedation to minimise motion artefacts. Sedation during Magnetic Resonance Imaging (MRI) poses many challenges to the anaesthetist. Inadequate or failed sedation results in difficulty in keeping them motionless while maintaining respiratory and hemodynamic stability. Secondly, limited access to the patient may pose a safety risk during MRI. Dexmedetomidine, an α2-adrenoceptor agonist, has recently been used as a sedative for diagnostic imaging studies. We report a use of dexmedetomidine for sedation in MRI suite in a child with frontonasal encephalocoele. A two-year-old girl child weighing 11 kg was scheduled for MRI of the brain and paranasal sinuses with nasal cavity under anaesthesia at our institute. After applying standard monitoring, an initial loading dose of dexmedetomidine was given @ 2 μg kg−1 over 10 min followed by continuous infusion of dexmedetomidine @ 1 μg kg−1 h−1. Sedation was monitored by the Ramsay Sedation Score (RSS), and as soon as a score of 5 was achieved, the child was transferred to the MRI table. Anaesthetic conditions were excellent, with minimal change in vital signs during the entire 35 min duration of the scan. Imaging was successful with no motion artefacts.
Related Knowledge Centers
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