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23 Cards in this Set
- Front
- Back
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When is paralysis used?
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when sedation alone doesn't improve effectiveness of mechanical ventilation
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What is advantage of paralysis?
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increases chest wall compliance and allows for adequate oxygenation and ventilation, drecreases oxygen consumption, improves blood gases, decrease risk for pneumothorax, decreases right to left shunting through ductus arteriosus and foramen ovale and increases oxygenation
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What is used for paralysis?
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pancuronium bromide
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How does pancuronium bromide cause skeletal muscle paralysis?
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competitively blocking acetylcholine at postsynaptic nicotine cholinergic receptors on muscle fiber of neuromusclular junction
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What is onset of pancuronium?
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minutes
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What is duration of pancuronium?
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1st dose 30-60 minutes and increases with each dose
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What is vecuronium?
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nondepolarizing neuromuscular blocker (like pancuronium)
commonly used in neonates |
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How is pancuronium eliminated?
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kidney
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How is vecuronium eliminated?
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biliary elimination (reduce dose in hepatic dysfunction)
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What is the greatest danger when using neuromuscular blocking agents?
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inadvertent disconnection from ventilator with resultant apnea
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What clinically important AE for neuromuscular blocking agents?
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tachycardia and fluid retention with significant edema
HTN, hypotension |
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Do neuromuscular blocking agents have any analgesic, sedative, or amnestic effects?
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no
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What is used for sedation and pain?
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morphine
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What can indicate seizure in paralyzed neonate?
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rhythmic fluctuations in HR, BP, ECG, and oxygenation
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What can be used for seizure?
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phenobarbital
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How is morphine clearance in neonates?
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reduced
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What AE for morphine?
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hypotension, decreased GI motility, respiratory depression, tolerance, physiological dependence
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What limits morphines use in neonates?
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histamine release and hypotension
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What is alternative to morphine?
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fentanyl
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What is fentanyl?
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synthetic opiate with less histamine releasing activity and fewer CV effects
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How is potency of fentanyl compared to morphine?
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50-100x more potent
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How long for d/c if opioid used less than 1 week at low to moderate dose?
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less than 72hrs, dose decreased 25-50% every 6-8hrs
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What are toxicities of chloral hydrate?
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CNS, respiratory, and myocardial depression, gastric irritation, adynamic ileus, cardiac arrhythmias, hypotension, renal impairment, bladder atony, direct hyperbilirubinemia
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