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A Lange Medical Book Pediatrics on call - part 6

Tránh ở những bệnh nhân bị động kinh thùy thái dương và tường ngực rối loạn chuyển hóa porphyrin cứng có thể xảy ra nhanh chóng IV đẩy chống chỉ định ở bệnh nhân tăng (ICP), IOP, rối loạn tâm thần, bệnh tuyến giáp | Methohexital Sedation sleep motion control Shorter painless procedures CT IV 1 mg kg PR 20 mg kg IV 1-2 PR 10-15 IV 15-30 PR 30-60 No Avoid in patients with temporal lobe epilepsy and porphyria Analgesics Fentanyl Analgesia Shorter moderately painful procedures IV 1-2 mcg kg may increase by 1 mcg kg q3-5min to desired effect IV 1-2 IV 30-60 Yes naloxone Chest wall rigidity may occur with rapid IV push Ketamineb Analgesia dissociation amnesia motion control Shorter moderately to severely painful procedures IV 1-1.5 mg kg IM 4-5 mg kg use concentrated 100 mg mL formulation PO 10 mg kg No reported max IV 1-2 IM 3-5 PO 10-30 IV 15-30 IM 30-90 No Contraindicated in patients with increased ICP IOP psychosis thyroid disease Nitrous oxide NO Reversal Agents Naloxone Mild analgesia sedation amnesia Narcotic reversal Mildly painful procedures Inhaled 30-50 NO mixed with oxygen IV IM 0.1 mg kg max 2 mg dose May repeat q2min 1-3 IV 2-3 PR 10-15 5 min IV 20-40 IM 60-90 No -- Contraindicated in patients with trapped gas pockets Sedative may outlast reversal agent Flumazenil Benzodiazepine reversal IV 0.02 mg kg per dose IV 1-2 IV 30-60 -- Sedative may outlast rever- May repeat qlmin sal agent to max of 1 mg 381 ABR auditory brainstem response CT computed tomography EEG electroencephalogram ICP intracranial pressure IOP intraocular pressure MRI magnetic resonance imaging. a Doses are generalizations only dosing must be individualized in all cases. Dosing may be altered by age or degree of illness. Neonatal dosing may differ. All PO PR IM dosing is difficult to titrate use caution and monitor for oversedation. Judicious use of local anesthetic may lessen dose requirements for systemic analgesia. b Administer with atropine 0.01 mg kg min 0.1 mg max 0.5 mg to blunt hypersalivation response. Some believe that administration with midazolam may ameliorate emergence phenomenon. All three drugs may be mixed together for IM administration. 382 I ON CALL PROBLEMS pharmacokinetics and .