vetgift.blogg.se - Precedex drip

Over time, the half-life of lidocaine may extend slightly (due to accumulation in various body compartments and also due to the inhibition of lidocaine metabolism by some of its own metabolites).However, some studies have reported the use of a continuous lidocaine infusion for four days or even 1-2 weeks! ( 14984229, 26650426) Most studies in the anesthesia literature have limited lidocaine infusions to 48 hours in duration. If acute organ failures occur (e.g., renal failure or multiorgan failure), then either close monitoring of drug levels or discontinuation of the infusion may be required. 🛑 Caution: Monitor the patient's organ function while on the lidocaine infusion.🛑 Caution: Many sources list higher infusion rates (e.g., 2-3 mg/kg/hour), but accumulation and shifts in metabolism over time may make these rates unsafe for extended infusion (e.g., >24 hours).Use of a relatively low, fixed lidocaine infusion rate may fit within this overall strategy. The whole concept of multi-modal analgesia is to use low doses of several medications, to avoid toxicity from any individual agent. Therefore, unless there is a high level of expertise regarding monitoring and dose-adjustment, it might be safest to use a fixed rate (especially at centers which are unable to measure a lidocaine level).

However, lidocaine has a relatively narrow therapeutic window (e.g., therapeutic level of ~2.5-3.5 ug/ml and toxic level of >5 ug/ml). Many sources recommend titration of the infusion based on pain.( 30303542) This will often be close to 1 mg/min, with some correction based on body size. ~1 mg/kg/hour ideal body weight appears to be a reasonable dose.(2) Continuous infusion at a low, fixed rate.~1.5 mg/kg infusion over 10-30 minutes (may use 1-2 mg/kg).Acetaminophen is a centrally acting, non-competitive reversible inhibitor of cyclooxygenase (COX) enzymes, with analgesic and antipyretic effects.RCTs and meta-analyses demonstrate that acetaminophen is an effective analgesic in a variety of contexts, with benefits which may include reduced opioid requirements, reduced delirium, and avoidance of nausea/vomiting. However, scheduled acetaminophen may nonetheless play a useful role in multi-modal analgesia. Acetaminophen is often overlooked because it isn't very potent. It forms the first level of the analgesic ladder due to its safety, rather than its efficacy.

Acetaminophen is a mild-moderately effective analgesic with an outstanding safety profile.

In neutropenia, acetaminophen might be avoided, to allow for early detection of neutropenic fever.

In acute liver injury or decompensated cirrhosis, acetaminophen should be entirely avoided.

In severe alcoholism, stable cirrhosis, or low body weight (<50 kg), the maximal daily dose is 2 grams.

Available RCTs have found no difference in efficacy between IV versus oral route.

PO is preferred, because IV is expensive (although this varies in different countries).

Acetaminophen may be given PO, PR, or IV.

For patients with ongoing pain this should be scheduled, to provide a baseline level of analgesia.

The usual dose is 650-1,000 mg q6hr (up to 4 grams/day).

Analgesia for patient on chronic buprenorphine ➡️.

Designing a sedative regimen for an intubated patient.

Targeting pain, anxiety, and agitated delirium.

Underlying concepts & construction of regimens:.

Butyrophenones (haloperidol & droperidol) ➡️.