450B.774 Procedure when patient refuses transportation to center for treatment of trauma. 1. If a patient at the scene of an injury refuses to be transported to a center for the treatment of trauma after a determination has been made that the patient's physical condition meets the triage criteria requiring transport to the center, the person providing emergency medical care shall evaluate the mental condition of the patient. If he determines that the patient is competent, the patient must be advised of the risks of not receiving further treatment at the center. If the patient continues to refuse to be transported to the center for treatment of trauma, the person providing emergency medical care shall request the patient to sign a statement indicating that he has been advised of the risks of not receiving further treatment at the center and continues to refuse to be transported to the center. The person providing emergency medical care shall inform a physician at the center for treatment of trauma of the patient's refusal to be transported to the center for treatment before he leaves the scene of the injury. If patient agrees to transport but requests a facility other than Renown Regional Medical Center, patient not family or friend ; , must be deemed competent to make such a decision. Base contact to Renown Regional Medical Center and receiving facility must be made for physician approval of diversion. If patient is deemed incompetent by the paramedic's best judgment, patient will be transported to Renown Regional Medical Center for evaluation and or treatment.
French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2004; 62: 1252-60. [PMID: 15111659] French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2004; 62: 1261-73. [PMID: 15111660], for instance, history of morphine!
Call To Order A meeting of the P & T Committee convened at 4: 00 p.m. on Wednesday, August 4, 2004. Introductory Remarks P&T Committee Chairman, Dr. LaCroix, recognized Jim Bracewell, SC Pharmacy Association Executive Director. On behalf of the Pharmacy Association, Mr. Bracewell welcomed the group. Mr. Bracewell invited anyone interested to participate in the SCPhA Pharmaceutical Industry Advisory Council. The organizational meeting will be held at the Pharmacy Association building on October 6th at 12: 00 noon. Committee Members Present: Edward M. Behling, M.D. Thomas Phillips, R.Ph. Joseph A. Horvath, M.D. Albert Humphrey, M.D. Robin K. LaCroix, M.D. James M. Lindsey, M.D. Mark A. O'Rourke, M.D. Deborah J. Tapley, R.Ph. George E. Vess, Pharm.D. Wayne Weart, Pharm.D. Jamee Lucas, M.D. Jerome E. Kurent, M.D.
On parenteral hyperalimentation, or have a severe intercurrent illness ; . Sincalide should be administered slowly over a 35 min duration ; to prevent biliary spasm and abdominal cramps. A slower infusion 3045 min ; may also be used see IV.F.3. ; . Orphine Sulfate: When acute cholecystitis is suspected and the gallbladder is not seen by 40-60 min, morphine sulfate, 0.040.1 mg kg, may be administered intravenously over 2-3 min. If the cystic duct is patent, flow of bile into the gallbladder will be facilitated by morphineinduced temporary spasm of the sphincter of Oddi. The intrahepatic biliary tree and common bile duct CBD ; must contain radioactive bile, and tracer activity should be present in the small bowel at the time of morphine injection. A second injection of radiopharmaceutical booster dose of approximately 1 mCi ; may be necessary prior to morphine if the remaining liver biliary tree activity appears insufficient to permit gallbladder filling. Shielding the bowel activity with lead may also be helpful. Imaging is usually continued for another 30 min following morphine administration but may be extended if desired. Contraindications to the use of morphine include respiratory depression in non-ventilated patients absolute ; , morphine allergy absolute ; and acute pancreatitis relative ; . Sincalide stimulation: Gallbladder contractility may be evaluated by determining the gallbladder ejection fraction GBEF ; response to sincalide. The study involves an intravenous injection over a minimum of 3 min or a 30-45 min infusion of 0.01- 0.02 g kg sincalide after the gallbladder is maximally filled with radiopharmaceutical usually 60 min after the injection ; and there is minimal activity in the liver. Computer acquisition 1-2 frames min ; then continues for 30 min. Various protocols can be employed. When performing and interpreting this procedure, the physician must adhere to a specific technique i.e., total dose of sincalide, dose rate and duration of infusion ; and normal values validated for that technique. Fatty meal stimulation: Gallbladder ejection fraction measurement using a fatty meal challenge instead of sincalide has also been described. If visual assessment of gallbladder emptying is sufficient, a fatty snack may be used. Phenobarbital: In jaundiced infants in whom biliary atresia is suspected, pretreatment with phenobarbital, 5 mg kg day, may be given.
Diphenhydramine benadryl ; in doses or 25 mgevery 6 hours should be used with morphine to prevent the itching often caused by histamine release caused by opiates.
Other experimenters report place preferences when morphine is paired with only visual rossi & reid, 1976 ; or visual and tactile bozarth & wise, 1981; phillips & le paine, 1980 ; stimuli; however, it is difficult to determine whether these paradigms are as sensitive in revealing the positive reinforcing properties of morphine as paradigms employing visual, tactile, and olfactory conditioned stimuli and naproxen.
The Cultural Competency Curriculum Modules are accredited for 9 Continuing Medical Education CME ; credits that may be completed in sets of 3 credits. This educational program is offered at no cost to you. To access this online program: thinkculturalhealth . Please feel free to provide any feedback regarding this experience directly to the Office of Minority Health or to Nannette Green, MHS, RN, CCM, Manager, Member Relations at Western Health Advantage n.green westernhealthadvantage.
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256. Which PCG s ; contain Morphjne Sulfate and what is the correct dosing? SEE PAGES 78, 90 & 91 257. Is Lasix used in our System? If so, in which PCG s ; and what is the correct dosing? SEE PAGE 91 258. Under which PCG s ; is it appropriate to utilize 2 inches of NTG paste? SEE PAGES 90 & 91 259. Which PCG s ; contain Lorazepam? What is the correct dosing and who can use it? SEE PAGES 78, 80 & 87 260. Which PCG s ; contain Dolasetron? What is the correct dosing and who can use it? SEE PAGE 73 261. What ETCO2 reading is considered a decision point for determination of pronouncement? SEE PAGES 24--26 & 92--94.
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MIRAPEX. 17 MIRENA . 38 mirtazapine . 10 misoprostol . 33 MITHRACIN . 16 mitomycin . 16 MOBAN . 17 MOBIC . 5, 12 mometasone crm, oint 0.1%. 30, 36 MONISTAT-DERM . 29 morphine ext-rel .5 MORPHINE inj .5 MORPHINE soln.5 morphine supp.5 MSIR .5 MUMPS VIRUS VACCINE LIVE ; . 40 mupirocin oint . 29 MUSE . 35 MUSTARGEN. 14 MYCOBUTIN . 14 nabumetone . 5, 12 nadolol . 21, 24 naloxone inj . 48 NALOXONE inj 1 mg mL, 0.02 mg mL . 48 naltrexone. 48 NAMENDA .9 naproxen . 5, 12 naproxen sodium . 5, 12 NARDIL. 10 NASACORT AQ . 45 NASAREL . 45 NASONEX. 45 NATACYN . 42 NAVANE 20 mg . 17 nefazodone . 10 neomycin polymyxin B dexamethasone. 42, 43 neomycin polymyxin B gramicidin . 42 neomycin polymyxin B hydrocortisone . 42, 43, 44 NEORAL . 41 NEULASTA. 23 NEUPOGEN . 23 NEURONTIN oral soln.9 NEXIUM . 33 NIASPAN. 26 nicotine transdermal . 32 65.
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Table 1. Demographic data and intraoperative factors. Group I II Intrathecal morphine n Age in years Length in cm Weight in kg Gender m f ; 0.025 35 62.6 ; 167.6 7.8 ; 69.5 11.4 ; 12 23 0.05 ; 169.5 8.2 ; 73.5 14.1 ; 10 27 and norvasc.
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This guide does not include all the ways to reduce osteoarthritis pain. Exercise, losing weight, acupuncture, and surgery are some other ways to help you feel better and stay active. It also does not cover opiate medications like morphine, Tylenol-3, and Vicodin and ortho.
Bleeding is a response to irreversible acetylation of platelets and interference of mucosal integrity. Death can occur from GI perforation or bleeding, especially in patients with Mallory-Weiss syndrome's slitlike tears. Choline magnesium trisalicylate CMT ; is an alternative salicylate derivative that is somewhat more gastroprotective and safer hemodynamically than aspirin. CMT is complementary to morphine for the treatment of metastatic bone pain.66 However, no studies to date have compared CMT with COX-2i. Nimesulide is a newer NSAID that provides greater selectivity to COX-2 than to COX-1. It possesses antipyretic and anti-inflammatory properties similar to other NSAIDs without significantly affecting cytoprotective prostaglandin in the gastric mucosa. Theoretically, proton-pump inhibitors or prostanoid analogs given with nonselective NSAIDs also could provide cytoprotection. One study showed that rofecoxib 50 mg provides better postoperative analgesia than does nimesulide 200 mg.67 Acetaminophen is hemodynamically safe and provides effective relief for mild pain. Short-term side effects are minimal as compared with narcotic combinations, except for in patients who misuse alcohol. Acetaminophen's most beneficial property is that it does not affect platelets either reversibly or irreversibly. It is unlike COX-2i, which bind reversibly only to COX-2. However, in a clinical trial of acetaminophen use in patients undergoing extraction of impacted third molars, about 75 percent of patients required analgesic rescue medication.68 Thus, acetaminophen possesses an analgesic ceiling effect. It also demonstrates one specific crucial disadvantage: severe hepatic damage even at therapeutic doses in chronic alcohol users.69 Therefore, dentists should be cautious when prescribing acetaminophen to alcoholics, owing to the possibility of severe liver toxicity even at normal doses.70 Unlike acetaminophen, rofecoxib is metabolized by the both the liver and the kidneys. It rarely is contraindicated for patients with liver dysfunction who need successful pain management. However, patients with gallbladder disease or a history of cholecystectomy will have impaired absorption and altered excretion because of bile's role in rofecoxib's pharmacodynamics.71 Injectable analgesics. Pediatric dentists and oral surgeons in a hospital environment can prescribe injectable analgesics such as morphine, fentanyl, ketorolac, meperidine, tramadol and.
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All morphine does is make you goofy enough that you can't remember that you have pain. The pain system is firing just as effectively." Thank you Adrien for making the coffee and tea. A total of $11 was collected in gold coin donation which helped pay room hire of $27.50 Tab was picked up by TNA Aust. Inc.
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Balin, but not morphine and amitriptyline, block both static and dynamic components of mechanical allodynia induced by streptozocin in the rat. Pain 1999; 80: 391-8. Cheng JK, Pan HL, Eisenach JC. Antiallodynic effect of intrathecal gabapentin and its interaction with clonidine in a rat model of postoperative pain. Anesthesiology 2000; 92: 1126-31. Field MJ, Holloman EF, McCleary S, Hughes J, Singh L. Evaluation of gabapentin and S- + ; -3-isobutylgaba in a rat model of postoperative pain. J Pharmacol Exp Ther 1997; 282: 1242-6. Jun JH, Yaksh TL. The effect of intrathecal gabapentin and 3-isobutyl -aminobutyric acid on the hyperalgesia observed after thermal injury in the rat. Anesth Analg 1998; 86: 348-54. Partridge BJ, Chaplan SR, Sakamoto E, Yaksh TL. Characterization of the effects of gabapentin and 3-isobutyl aminobutyric acid on substance P-induced thermal hyperalgesia. Anesthesiology 1998; 88: 196-205. Hwang JH, Yaksh TL. Effect of subarachnoid gabapentin on tactileevoked allodynia in a surgically induced neuropathic pain model in the rat. Reg Anesth 1997; 22: 249-56. Chen SR, Eisenach JC, McCaslin PP, Pan HL. Synergistic effect between intrathecal non-NMDA antagonist and gabapentin on allodynia induced by spinal nerve ligation in rats. Anesthesiology 2000; 92: 500-6. Kayser V, Christensen D. Antinociceptive effect of systemic gabapentin in mononeuropathic rats, depends on stimulus characteristics and level of test integration. Pain 2000; 88: 53-60. Hunter JC, Gogas KR, Hedley LR, Jacobson LO, Kassotakis L, Thompson J, Fontana DJ. The effect of novel anti-epileptic drugs in rat experimental models of acute and chronic pain. Eur J Pharmacol 1997; 324: 153-60. Singh L, Field MJ, Ferris P, Hunter JC, Oles RJ, Williams RG, Woodruff GN. The antiepileptic agent gabapentin Neurontin ; possesses anxiolytic-like and anti- nociceptive actions that are reversed by D-serine. Psychopharmacology Berl ; 1996; 127: 1-9. Kim SH, Chung JM. An experimental model for peripheral neuropathy produced by segmental spinal nerve ligation in the rat. Pain 1992; 50: 355-63. St rkson RV, Kj rsvik A, Tj lsen A, Hole K. Lumbar catheterization of the spinal subarachnoid space in the rat. J Neurosci Methods 1996; 65: 167-72. Hargreaves K, Dubner R, Brown F, Flores C, Joris J. A new and sensitive method for measuring thermal nociception in cutaneous hyperalgesia. Pain 1988; 32: 77-88. Taylor CP, Gee NS, Su TZ, Kocsis JD, Welty DF, Brown JP, Dooley DJ, Boden P, Singh L. A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Res 1998; 29: 233-49. Suman-Chauhan N, Webdale L, Hill DR, Woodruff GN. Characterization of 3[H]gabapentin binding to a novel site in rat brain: homogenate binding studies. Eur J Pharmacol 1993; 244: 293-301.
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Terms and Conditions of Purchase Robot Parts and Components Foster-Miller, Inc. the "Buyer" ; is purchasing off the shelf or customized parts, components, or assemblies from your organization the "Seller" ; for its proprietary remote controlled robotic vehicles the "Robots" ; , including Buyer's proprietary TALON Robots. As such Buyer and Seller agrees that for all sales of parts, components, or assemblies that Buyer purchases from Seller, the following terms and conditions shall govern: I. Acceptance: This purchase order constitutes Buyer's offer to Seller and shall become a binding contract upon the terms and conditions set forth herein upon acceptance by Seller, either by returning the signed acknowledgement copy hereof or by the commencement of performance. In the event that this order does not state price or delivery, Buyer will not be bound to any price or delivery to which it has not specifically agreed in writing. Any terms or conditions proposed by Seller inconsistent with or in addition to the terms and conditions of this purchase order are hereby objected to, and shall be void and of no effect, unless specifically agreed to in writing by Buyer. Modifications hereof or additions hereto, to be effective, must be made in writing and be signed by Buyer. This purchase order, together with such modifications as are accepted in writing by Buyer, constitute the entire agreement between the parties. II. Delivery: Time is and shall remain of the essence of this order, and no acts of Buyer, including without limitation modifications of this order or acceptance of late deliveries, shall constitute waiver of this provision. Delivery shall be strictly in accordance with the delivery schedule set out or referred to on this purchase order. Buyer may refuse to accept, or return at Seller's risk and expense, any shipments made in excess of Buyer's order or in advance of required delivery dates, or at Buyer's option, to accept early deliveries and defer payment on such deliveries until such dates. Seller shall notify Buyer immediately of any actual or potential labor dispute which is delaying or threatens to delay the timely performance of this order. If deliveries are not made at the specified time, Buyer, in addition to its other remedies, reserves the right to cancel or to purchase elsewhere, and hold Seller accountable therefore. III. Termination: a ; Buyer may terminate this order without liability to Seller, except for work previously performed, if Seller ceases to conduct its operations in the normal course of business including inability to meet its obligations as they mature ; or if any proceeding is brought against or instituted by Seller under the bankruptcy or insolvency laws, or if a receiver for Seller is appointed or applied for, or if an assignment for the benefit of creditors is made by Seller. b ; Buyer may terminate this order without liability to Seller, except for product previously delivered, if Seller fails to deliver in accordance with the delivery schedule specified on the face of this order, provided that such delivery schedule is specifically stated. c ; Buyer may at any time terminate this order in whole or in part for its convenience upon written notice to Seller in which event Seller shall be entitled to reasonable termination charges consisting of a percentage of the order price reflecting the percentage of the work performed prior to termination plus actual direct costs necessarily resulting from such termination. In no event shall Seller be entitled to anticipatory profits or to special or consequential damages. IV. Warranties: Seller warrants that all materials and work covered by this order will conform to applicable specifications, drawings, samples and or other descriptions given, be free from defects in materials or workmanship, and suitable for the purposes intended by Buyer. Unless the materials or articles covered by this order are manufactured completely to detailed designs furnished by Buyer, Seller additionally warrants the design to be free from defects. No approval of any design by Buyer shall constitute a waiver by Buyer of Seller, together with its service warranties and guarantees, shall run to Buyer and or its customers, and shall survive inspection, acceptance and payment and penicillin and morphine, for instance, morpyine yes.
3. Current Drug Costs The examples below illustrate the substantial drug costs associated with treating patients with selected autoimmune disorders.
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Materials and Methods Subjects. Two female and one male patas monkeys Erythrocebus patas ; housed individually with free access to water served as subjects. They were maintained at about 90% of their freefeeding weights on a diet consisting of Purina Monkey Chow, fresh fruits, vitamins fed in their home cages, and Noyes banana-flavored pellets received during experimental sessions. All three subjects had extensive experience with the behavioral procedure used and had been exposed to a variety of drugs in the past but were drug-free for at least 8 mo before beginning the present study.
INTRODUCTION Background and Significance Pain is an unpleasant sensory and emotional experience.1 Pain is a complex phenomenon derived from sensory stimuli or neurologic injury and modified by individual memory, expectations, and emotions.2 Pain is usually associated with injury or a pathophysiologic process that causes an uncomfortable experience and is usually described in such terms. Although there are no objective biologic markers of pain, an individual's description and selfreport usually provides accurate, reliable, and sufficient evidence for the presence and intensity of pain.3 Persistent pain can be defined as a painful experience that continues for a prolonged period of time that may or may not be associated with a recognizable disease process. The terms persistent and chronic are often used interchangeably in the medical literature. Unfortunately for many elderly persons, chronic pain has become a label associated with negative images and stereotypes often associated with longstanding psychiatric problems, futility in treatment, malingering, or drug-seeking behavior. The term persistent pain may foster a more positive attitude by patients and professionals for the many effective treatments that are available to help alleviate suffering.4 The clinical manifestations of persistent pain are commonly multifactorial. Because of the complex interplay among these factors across several domains physiologic, psychologic, and social ; , discriminating which factors are most important for the purpose of treatment can be very challenging. Further complicating this task is the fact that pain expression and hence the importance of specific factors commonly vary, not only across individuals but also over time in one individual. Elderly persons have been defined by demographers, insurers, and employers as those aged 65 years and over. In healthcare discussions, the elderly persons often de.
Background: Alzheimer's disease AD ; and Parkinson's disease PD ; are characterized by a loss of cholinergic neurons and dopaminergic neurons, respectively. Although, these clinical syndromes have originally been described as two distinct diseases, there is an overlap in clinical and pathological features in these patients. Methods: To study a possible interaction between dopamine and acetylcholine neurons, we have lesioned the dopaminergic neurons in the ventral tegmental area VTA ; and the cholinergic neurons in the nucleus basalis magnocellularis NBM ; with 6-OHDA and 192 IgG-saporin, respectively. Five weeks after surgery, the animals were assessed for deficits in learning and memory in the Morris water maze test. Results: A significant increase in latency to find the platform was found in VTA lesion alone and NBM + VTA lesion groups, but not in NBM lesion alone group. In addition, we also looked at activity levels under basal conditions and after an injection with a low dose of apomorphine. We saw an increase in activity in the VTA leison alone and the VTA + NBM lesioned animals. No significant difference was found in the skilled paw use test in the staircase between all the groups. Conclusion: Our findings suggest that the dopamine neurons in the VTA have an important function in learning. However more research is needed.
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Heroin Addiction and Related Clinical Problems Psychopathological Symptoms during Methadone Maintenance. J Psychoactive Drugs. 25 3 ; : 253-263. Maremmani I., Zolesi O., Daini L., Castrogiovanni P., Tagliamonte A. 1995 ; : Fluoxetine improves outcome in Addicted Patients Treated With Opioid Antagonists. J Addict. 4 3 ; : 267-271. Martin J., Ingles J. 1965 ; : Pain tolerance and narcotic addiction. Br J Soc Psychol. 4: 224-229. Martin W. R. 1972 ; : Pathophysiology of narcotic addiction: possible role of protracted abstinence in relapse. In C. J. Zarafonetis Ed., Drug abuse. Lea and Febiger, Philadelphia. pp. 153-159. Martin W. R., Hewett B. B., Baken A. J., Heartzen C. A. 1977 ; : Aspects of the psychopathology and pathophysiology of addiction. Drug Alcohol Depend. 2: 185202. Martin W. R., Jasinski D. R. 1969 ; : Physiological parameters of morphine dependence in man, early abstinence, protracted abstinence. J Psychiatr Res. 7: 9-17. Martin W. R., Jasinski D. R., Mansky P. A. 1973 ; : Naltrexone, an antagonist for the treatment of heroin dependence. Arch Gen Psychiatry. 28: 784-791. Marzuk P. M., Mann J. J. 1988 ; : Suicide and Substance abuse. Psychiat Ann. 18: 630639. Mason B. J., Kocsis J. H., Melia D., Khuri E. T., Sweeney J., Wells A., Borg L., Millman R. B., Kreek M. J. 1998 ; : Psychiatric comorbidity in methadone maintened patients. J Addict Dis. 17 3 ; : 75-89. Mc Kenna G. J. 1973 ; : The use of methadone as a psychotropic agent. Nat Conf Methadone Treat Proc. 5: 1317-1324. McEvoy J, Freudenreich O., Levin E., Rose G. E. 1995 ; : Haloperidol increases smoking in patients with schizophrenia. Psychopharmacology Berl ; . 119: 124-126. McEvoy J, Freudenreich O., McGee M., VanderZwaag C., Levin E., Rose J. 1995 ; : Clozapine decrease smoking in patients with chronic schizophrenia. Biol Psychiatry. 37: 550-552. McLellan A. T. 1986 ; : "Psychiatric severity" as a predictor of outcome from substance abuse treatments. In R. E. Meyer Ed., Psychopathology and Addictive Disorders. Guilford Press, New York. McLellan A. T., Arndt I. O., Metzger D. S., Woody G. E., O'Brien C. P. 1993 ; : The effects of psychological services in substance abuse treatment. JAMA. 269: 1953-1959. McLellan A. T., Luborsky L., Woody G. E., Druley K. A., O'Brien C. P. 1983 ; : Predicting response to alcohol and drug abuse treatments: role of psychiatric severity. Arch Gen Psychiatry. 40: 620-625. McLellan A. T., O'Brien C. P., Kron R., Druley K. A., Alterman A. I. 1980 ; : Matching substance abuse patients to appropriate treatments. Drug Alcohol Depend. 5 3 ; : 189195. McLellan A. T., Woody G. E., O'Brien C. P. 1979 ; : Development of psychiatric illness in drug abusers: Possible role of drug preference. N Engl J Med. 301: 1310-1314. Mehrabian A., O'Reilly E. 1988 ; : Personality correlates of habitual alcohol use. Int J Addict. 23 2 ; : 175-182. Meltzer H. Y. 1991 ; : The mechanism of action of novel antipsychotic drugs. Schizophr Bull. 17: 263-287. Mezzich J. E., Ahn C. W., Fabrega H. 1990 ; : Patterns of Psychatric Comorbidity in a large popuation presenting for care. In J. D. Maser, C. R. Cloninger Eds, Comorbidity of Mood and Anxiety disorders. American Psychiatric Press, Washington. Miles C. P. 1977 ; : Conditions predisponing to suicide: a review. J Nerv Ment Dis. 164: 230-231.
Approximately 6 hours after necrosis onset. Troponin and CKMB peak within the first 24-36 hours after the MI; CKMB, however, will usually return to normal ranges within 2 days, while troponin will often stay elevated for up to 5 days. Initial management of coronary ischemia includes administration of an aspirin, -blocker, nitroglycerin, morphine, and heparin.1 The 2004 update of the ACC AHA Guidelines for the Management of Patients with STEMI addresses care of the AMI patient during the initial phase and it also discusses post-MI management. These Guidelines describe 3 different classes of recommendations--I, II, and III: Class I recommendations are conditions for which there is evidence and or general agreement that a procedure or treatment is beneficial, useful, and effective.5 Class II recommendations are based upon evidence for which there is conflicting data or differences of opinion but are generally considered useful. Class III recommendations describe conditions for which the treatment is not useful and, in some cases, may actually be harmful.
EFFECTS OF DEXMEDETOMIDINE ON OPIOID AND BENZODIAZEPINE DOSING REQUIREMENTS IN CHILDREN AFTER CARDIAC SURGERY Amy E Helvie * , Chad A. Knoderer, Brandon T. Kibby, Stephen M. Mazurek Clarian Health Partners, 702 Barnhill Drive, Room 1016, Indianapolis, IN, 46202 ahelvie clarian Background Opioids and benzodiazepines are the cornerstone of pain and sedation management in critically ill children. Dexmedetomidine is a potent and selective alpha2-adrenergic agonist which has sedative, analgesic, and anxiolytic effects. In adults, dexmedetomidine has been shown to decrease dosing requirements of opioids when added to pain and sedation protocols. Limited data have been published regarding dexmedetomidine use in children. However it may be hypothesized that similar to adult data, the addition of dexmedetomidine to standard pain and sedation management protocols in pediatric patients may reduce the overall narcotic and benzodiazepine dosing requirements. Objective The objective of this study is to determine any difference in narcotic and benzodiazepine dosing requirements in pediatric cardiovascular surgery patients treated postoperatively with or without dexmedetomidine. Methods This is a retrospective cohort study. A computer-generated list of pediatric cardiovascular surgery patients less than 18 years was used to capture both case and control subjects. The case group consists of those patients who received dexmedetomidine postoperatively between January and June 2006, and will be compared to a historical control group of pediatric patients that did not receive dexmedetomidine postoperatively. Baseline demographic and clinical characteristics of the patients in the two groups will be compared. Utilizing the medication administration record cumulative opioid and benzodiazepine dosing requirements for each patient will be evaluated. Opioid dosing will be reported as standardized equivalent morphine doses. Benzodiazepine dosing will be reported as standardized equivalent midazolam doses based on our institutional standard conversion. Dosing requirements between the two groups will be compared to determine the impact of dexmedetomidine on cumulative opioid and benzodiazepine doses. Results and Conclusions Results and conclusions are pending and will be presented upon completion of data collection. Learning Objectives: Describe the impact of dexmedetomidine use on opioid and benzodiazepine dosing requirements in pediatric patients. Understand the pharmacologic differences between dexmedetomidine and opioids. Self Assessment Questions: Dexmedetomidine is a selective alpha2-adrenergic agonist. T F Dexmedetomidine does not have sedative properties. T F.
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