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Patient 67 years old (Medication (Fentanyl ((Therapeutic indications,…
Patient 67 years old
Medication
Fentanyl
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• analgesic action of short duration during anaesthetic periods, premedication, induction and maintenance, and in the immediate post-operative period (recovery room) as the
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premedication, for the induction of anaesthesia, and as an adjunct in the maintenance of general and regional anaesthesia.
Morphine
Morphine is an opioid analgesic. It acts mainly on the central nervous system and on smooth muscle. Morphine combines selectively at opioid binding sites found in the CNS and smooth muscle to produce its pharmacologic effects. These are due to morphine mimicking the action of endogenous endorphins, which are released in response to pain and other stimuli. Morphine relieves most types of pain but is more effective against dull, constant pain than sharp, intermittent pain. Analgesia at the supraspinal level results principally from combination with (mu) receptors. (kappa) receptors are responsible primarily for expression of analgesia at the spinal level. In addition to relieving severe constant pain, morphine also alleviates the associated anxiety.
Dexamethazone
Dexamethasone is indicated for replacement therapy in secondary adrenal insufficiency arising from insufficient corticotrophin secretion. It is not indicated for primary adrenal insufficiency states, such as Addison’s disease or after adrenalectomy. In such cases hydrocortisone and fludrocortisone in combination is more appropriate.
Ondansatron
Ondansetron is a potent, highly selective 5HT3 receptor-antagonist. Its precise mode of action in the control of nausea and vomiting is not known. Chemotherapeutic agents and radiotherapy may cause release of 5HT in the small intestine initiating a vomiting reflex by activating vagal afferents via 5HT3 receptors. Ondansetron blocks the initiation of this reflex.
History: depression, 1st spinal washout, previous surgery on spinal lower back
Prior to surgery B/P was 140/95, patient had previously been Fasting for 8 hours prior
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IV line in right hand
Plasma lite 148, 1000ml Bag
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