LAB et al.....(Started working).....LOL😆😆😆😆 labetalol SAGA

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💉Comes as 5  mg/mL  ampoules 

💉Infusion:  200 mg/200  mL 

     Add  200mg  [40  mL]  labetalol  to  160  mL  D5W,      NS,  LR,  or  D5/NS 

     Final  concentration:  1  mg/mL 

💉Blocks  α,  β1,  and  β2  adrenergic  receptor  sites.    

💉Decreases  heart  rate  and  peripheral  vascular  resistance.  

💉Ratio  of  alpha-‐  to  beta-‐ blockade  depends  upon  the  route  of  administration  (1:3  oral  versus  1:7  IV)  

💉Onset  of  action:  2-‐ 5  minutes  

💉Duration:  2-‐ 4  hours

💉IV  Bolus:  20  mg  over  at  least  2  minutes  as  initial  dose, may  repeat  with  doses  of  40-‐ 80  mg  q10min; Do  not  exceed  total  dose of 300 mg 

💉 Infusion:  starting  2  mg/min  (2  mL/min)  –  8  mg/min  titrated  to  response.   Do  not  exceed  total  dose  of  300

💉As  cumulative  dose  nears  300mg  IV,  duration  of  action  extends  to  nearly  18  hours.

🙀-NEW INSIGHTS: 

Antihypertensive drugs methyldopa, labetalol, hydralazine, and clonidine improve trophoblast interaction with endothelial cellular networks in vitro

B Xu, F Charlton, A Makris, A Hennessy - Journal of hypertension, 2014 

#anesthesia , #GDM , #PIH , #anaesthesia

BASIC INFO: Guillain-Barre Syndrome in Neuro Critical Care Unit

🔵is an Acute Inflammatory Demyelinating Polyneuropathy (AIDP) 

🔵There will be diffuse weakness, areflexia and albuminocytologic dissociation. 

🔵In ~60% there can be preceding upper respiratory infection or diarrhea with 30% of these cases attributed to Campylobacter jejuni  

🔵Neurologic symptoms: numbness, paraesthesias, dysesthesias and progressive, bilateral symmetric weakness that progresses over hours to days and peaks in a few weeks. 

🔵normal or hyperreflexia in the initial phase changes to  areflexia. 

🔵CSF : elevated protein without pleocytosis (albuminocytologic dissociation is seen with only in 50% of patients during their first week of illness and up to 75% by the third week)

🔵Lumbar puncture is necessary to rule out infectious diseases and malignancies. 

🔵Medical complications : Respiratory failure and need for mechanical ventilation, aspiration pneumonia, sepsis, arrhythmias, cardiac arrest, and dysautonomia. 

🔵Screening for dysphagia and frequent bedside spirometry is necessary to prevent aspiration and further respiratory compromise. 

🔵They often require narcotics, gabapentin or carbamazepine to manage their acute pain (A small portion of patients will continue to experience radicular, arthralgia or meningitic pain up to one year later.) A dual approach of psychosocial support and SSRI therapy is recommended. 

🔵 both PLEX and IVIG are effective therapies for patients with GBS. 

🔵 Patients admitted within two weeks of symptom onset, bed bound on admission, and those that have minimal comorbidities can be considered for PLEX first. 

🔵 IVIG is may be easier to administer, especially when placement of a central line is not readily available. 

🔵 A Cochrane systematic review published in 2012 concluded that PLEX is more effective than supportive care, IVIG may be slightly safer, and combination therapy was not more effective than monotherapy 

Reference :

>Jacob S, Viegas S, Lashley D, Hilton-Jones D (2009) Myasthenia gravis and other neuromuscular junction disorders. Pract Neurol 9: 364-371. 

>Hughes RA, Swan AV, van Doorn PA (2012) Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. Wil ey Online Library 7.

>Bedside Critical Care Guide / Ramzy H Rimawi

#GBS , #GBSICU , #PLEX, #neuroicu ,#neurology ,#anaesthesia ,#anesthesiologist

THE DICTATORS OF NIGHT👑💤; NREM Vs REM COMPARISON↔️

🎭Cerebral blood flow is reduced in NREM , whereas it is markedly increased in REM

🎭Sleep walks and night terrors occur in NREM; whereas dreams occur in REM

🎭Muscle tone, especially, Upper airway muscle tone is significantly reduced in REM. 

🎭DO YOU KNOW❓The only somatic muscles working in REM are the extraocular muscles and diaphragm❗️❗️

🎭There is a shift in the autonomic nervous system in sleep, with parasympathetic nervous system predominance in NREM and especially in REM

🎭NREM is organized into four stages. In a typical night of adult sleep, Stage 1 will comprise up to 5% of total sleep, Stage 2 up to 50%, SWS ( Slow Wave Sleep= Stage 3+4) up to 20%, and REM up to 25%

🎭SWS is predominately experienced in the first third of sleep and REM in the last half of sleep. Achieving SWS has neuroendocrine significance.

〰NEW INSIGHTS〰

😴Unlike propofol, sevoflurane anesthesia has differential effects on NREM and REM sleep homeostasis. (i.e.  Total sleep deprivation resulted in significantly increased NREM and REM sleep for 12-h postdeprivation. Sevoflurane exposure after deprivation eliminated the homeostatic increase in NREM sleep and produced a significant decrease in the NREM sleep δ power during the postanesthetic period, indicating a complete recovery from the effects of deprivation)

These data confirm the previous hypothesis that inhalational agents do not satisfy the homeostatic need for REM sleep, and that the relationship between sleep and anesthesia is likely to be agent and state specific.

(Pal D, Lipinski WJ, Walker AJ, Turner AM, Mashour GA

Anesthesiology [2011, 114(2):302-310)]

😴Help your patient in getting a quality sleep on preoperative day❗️

Sleep Loss and REM Sleep Loss are Hyperalgesic

Timothy Roehrs, Maren Hyde, Brandi Blaisdell, M Mark Greenwald, Thomas Roth (SLEEP, Vol. 29, No.2, 2006)

#sleep ,#nremsleep , #rem , #SleepClinic , #SleepStudy , #AnaesthesiaSleep ,#osas ,#cpap ,#brain , #SWS

HYPOPHOSPHATAEMIA IN ICUs🌀

🔹Normal range (2.5-4.5 mg/dL),

🔹Plasma phosphate concentration < 2.5 mg/dL or 0.81 mmol/L

CAUSES:

🔹Poor Nutrition

🔹Chronic Alcoholism

🔹Diarrhoea

🔹Beta 2 Agonists

🔹Insulin 

🔹Acetazolamide

🔹Hemodialysis 

🔹Hyperparathyroidism

EFFECTS

🔹Irritability 

🔹Confusion

🔹Metabolic encephalopathy 

🔹Coma

🔹Muscle weakness 

🔹Respiratory failure

🔹Failure to wean from ventilator

🔹Dysphagia

🔹Ileus

🔹cardiac arrhythmias and cardiomyopathy.

🔹ODC shift to left

TREATMENT

🔹Asymptomatic mild-to-moderate hypophosphatemia (1-2.5 mg/dL) can be treated with oral phosphate supplementation if the gastrointestinal tract is intact. 

🔹Symptomatic or severe hypophosphatemia (< 1.0 mg/dL) should be treated with intravenous phosphate.

🔹Oral supplementation : 2.5 to 3.5 g (80 to 110 mmol) per day, divided over two to three doses.

Intravenous:

🔹The required dose of initial intravenous phosphate may vary from 2.5 to 19.8 mg/kg.

Typically, 2-5 mg/kg of inorganic phosphate dissolved in 0.45% saline is given over 6-12 hours and repeated as needed.

🔹Rapid or large infusions are dangerous : Large intravenous doses of phosphate may result in hyperphosphatemia, hypomagnesemia, hypocalcemia, and hypotension.

🔹Hyperkalemia is prevented by using sodium phosphate instead of potassium phosphate in patients with potassium levels >4 mmol/L.

🔹Do not mix with Calcium or Magnesium

🔹Daily Phosphate level monitoring should be done

#hypophosphaetemia , #phosphorous , #electrolytes , #icu , #criticalcare , #IntensiveCare