ipl-logo

Dexmedetomidine Case Study

1511 Words7 Pages

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

Show More
Related
242 Words | 1 Pages

Justin 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.

Read More
262 Words | 2 Pages

Scope 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.

Read More
1209 Words | 5 Pages

Mr. 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.

Read More
443 Words | 2 Pages

Dexmedetomidine is not indicated for infusions lasting longer than 24 hours. Dexmedetomidine has been continuously infused in mechanically ventilated patients prior to extubation, during extubation, and post-extubation. It is not necessary to discontinue Dexmedetomidine

Read More
1831 Words | 8 Pages

Anaesthetic Phase According to the HPC Code of Conduct (2015), all registrants and students must respect service user’s right of confidentiality. Therefore, the author will fictionally refer the patient as Sibert. Before Sibert came to theatre for surgery, a pre-assessment is conducted in the pre-assessment clinic. During this assessment, medical history, general health and family history are checked and assessed.

Read More
1210 Words | 5 Pages

Art 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,

Read More
822 Words | 4 Pages

A correct analgesia may also allow the patient to be mobilized faster and begin earlier respiratory physiotherapy

Read More
644 Words | 3 Pages

Etomidate 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.,

Read More
1301 Words | 6 Pages

This helps provide more patient centered care. Guidelines to follow after opioid administration will vary by hospital but it is still necessary to use sedation scales with acceptable measures of reliability and validity for pain management. The use of sedation scales should be used with consistent monitoring of respirations. Pasero (2009) emphasizes that a comprehensive evaluation of respiratory status that includes depth, regularity, rate, and noisiness of respiration in addition to sedation assessment is essential to decision making during opioid administration for pain management. Respirations should be counted for a full minute while the patient is at rest in a quiet and relaxed environment.

Read More
136 Words | 1 Pages

Methadone 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).

Read More
357 Words | 2 Pages

The etiology of PONV is multifactorial during laparoscopic cholecystectomy, therefore, combination of different classes of anti-emetics are preferred to control PONV, [6] [7] [205,206] including anticholinergics, antihistamines, butyrophenones, benzamide, dexamethasone and 5-HT3 antagonists. Ondansetron, 5- hydroxytryptamine type 3 (5-HT3) receptor antagonist, blocks receptors in the CTZ as well as vagal nerve terminals. Dexamethasone has been used as an anti-emetic for a long time with limited adverse effect. The exact anti-emetic mechanism of dexamethasone is unknown, but it is thought to enhance the anti-emetic effect of 5-HT3 receptor antagonists [8] [208] that is central/peripheral inhibition of production of 5-HT, central inhibition of synthesis of prostaglandins, changes in permeability of the blood brain barrier to plasma proteins, or by releasing endorphins.[9]

Read More
252 Words | 2 Pages

Diagnosing 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.

Read More
960 Words | 4 Pages

Volatile anesthetics can alter the dopaminergic balance in the brain, but whether they exacerbate PD is unknown. Propofol produces both dyskinesias and ablation of resting tremor, suggesting that it has both excitatory and inhibitory effects in this patient population. But both volatile agents as well as propofol has been successfully to sedate patients with PD during deep brain stimulation surgery. Dexmeditomidine appears to be safe and when used in deep brain stimulation surgery has advantage of not interfering with motor symptoms. Ketamine should be used with caution because of potential interaction between levodopa and ketamine’s sympathomimetic activity.

Read More
717 Words | 3 Pages

Management and outcome The surgery was successful. The anaesthetist told me he will be like to do awake extubation because patient was grade 2 view on intubation. This method is used to perform an extubation once the patient is fully awake and able to maintain his own airway (e SAFE, 2017) I prepared for awake extubation, all the airway equipment for the intubation were kept for anaesthetic emergence, guedel, laryngoscope, bougie, 20ml syringe.

Read More
810 Words | 4 Pages

The exposure of anesthetist to inhalational anesthetics is higher as compared to other operation theater personals and may even cross the limits of environmental tolerance. (Sukhminder & Jasbir,

Read More

More about Dexmedetomidine Case Study

Related Topics

Open Document