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Sedation - Coggle Diagram
Sedation
PRIS
Dexcription
Rhabdomyolysis
High CK
Hyperkalameia
AKI
Lipaemic plasma
Fatty liver
Metabolic acidosis BE>-10
Risk factors
4mg/kg/hour
Young
low glycogen stores
Recommended against infusion for children <16
Brian injury
Low carbohydrate intake
High catecholamine levels
Glucocorticoids
Genetic fatty acid metabolism mutations
ECG
Bradycardia
Brugada like pattern (coved-type ST elevation in V1-2)
Varying degrees of heart block
RBBB
Unexplained arrythmias
Treatment
Stop infusion
Supportive
vasoactives
Rhabdo treatment
target UO 2-3mls/kg/hour
urinary alkalinisation
diuretics
treatment for hyperkalameia
tamporary pacing
VA ECMO
Remifentanyl
Description
phenylpiperidine
synthetic
pure mew agonist
ADME
metabolised by nonspecific esterases
Duration of action determined by elimination rather than distribution
Why used
context sensitive half life of 3-8 minutes
analgesic will wear off rapidly
context sensitive half = duration fo infusion, clearance due to redistribution to clearance due to elimination
Propofol
Descrition
2,6 di-isopropyl-phenol
lipid emulsion
contains soya beans
contains egg
weak organic acid with pKa of 11
ADME
Vd =4l
hepatic metabolism
excreted by urine
Adverse effects
Apnoea
Reduction in SVR leading to hypotension
Bradycardia
Green discolouration of urine
RASS
3c rule
Calm
Cooperative
Comfortable
RASS -3--5
Brain injury and raised ICP
NMBAs
Severe ARDS
Ventilator dysyncrony
Strict immoblisation eg spinal fractures
Status epilepticus