Anticholinergics in Asthma treatment

Anticholinergics inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone of the airway.

In general, anticholinergics are not first-line therapy for asthma.
According to the NAEPP guidelines, they may be used in conjunction with SABA in severe exacerbation in the emergency department.
The addition of ipratropium has not been shown to provide further benefit once the patient has been hospitalized.

For adults, the doses for ipratropium bromide for asthma exacerbation,
Nebulized solution (0.25 mg/mL): 0.5 mg or 500 mcg every 20 minutes for 3 doses, then as needed.

Albuterol and ipratropium are often mixed in the same nebulizer. If given concurrently, the dosing of albuterol and ipratropium is:

Nebulizer (each 3ml vial contains 2.5 mg albuterol + 0.5 mg ipratropium bromide):

3 mL every 20 minutes for 3 doses, then as needed. This regimen may be used for up to 3 hours in the initial management of severe exacerbations although the addition of ipratropium to albuterol has not been shown to provide further benefit once the patient has been hospitalized

Comments

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is caffeine prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg, dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...

sedationstation

Search This Blog