Apnea

Propanidid. Propanidid [1421-14-3] (Epontol), C gH2yNO, (7) a derivative of the propyl ester of homo vanillic acid, has been in clinical use in Europe for a number of years. Its main advantage is rapid onset of action and a fast recovery which, like etomidate, is because of rapid metaboHsm by esterases rather than redistribution (108). Excretion is rapid 75 to 90% of the dmg is eliminated as metaboUtes within two hours. Propanidid side effects include hypotension, tachycardia, and hyperventilation followed by apnea, as well as excitatory side effects such as tremor and involuntary muscle movement (109). 

Benign familial neonatal convulsion is an idiopathic form of epilepsy beginning within the first six months after birth. Seizures include generalized and mixed, starting with tonic posture, ocular symptoms, and apnea, and often progress to clonic movements and motor automatisms. 

Small-conductance (SKCa) Sleep apnea Dequalinium, Tubocurarine,... 

Neurotoxicity (damage to the nervous system by a toxic substance) may also be seen with the administration of the aminoglycosides. Signs and symptoms of neurotoxicity include numbness, skin tingling, circum-oral (around the mouth) paresthesia, peripheral paresthesia, tremors, muscle twitching, convulsions, muscle weakness, and neuromuscular blockade (acute muscular paralysis and apnea). 

Nursing care includes close monitoring of the patient immediately after insertion of the epidural catheter and throughout therapy for respiratory depression. Vital signs are taken every 30 minutes, apnea monitors are used, and a narcotic antagonist, such as naloxone, is readily available... 

Respiratory—hypoventilation, apnea, respiratory depression, bronchospasm, laryngospasm... 

Older or debilitated adults may require a reduced dosage of diazepam to reduce ataxia and oversedation. The nurse observesthese patients carefully. Apnea and cardiac arrest have occurred when diazepam is administered to older adults very ill patients and individuals with limited pulmonary reserve. 

Parenteral (IV or IM) administration to older adults the debilitated, and those with limited pulmonary reserve requires that the nurse exert extreme care because the patient may experience apnea and cardiac arrest. Flesuscitative equipment should be readily available during parenterat (particularly IV) administration. 

Antiemetics and antivertigo drag s are used cautiously in patients with glaucoma or obstructive disease of the gastrointestinal or genitourinary system, those with renal or hepatic dysfunction, and in older men with possible prostatic hypertrophy. Piromethazine is used cautiously in patients with hypertension, sleep apnea, or epilepsy. Trimethobenzamide is used cautiously in children with a viral illness because it may increase the risk of Reye s syndrome... 

Streptokinase is not used for restoring IV catheter patency. Serious adverse reactions induding hypotension, hypersensitivity apnea, and bleeding, have occurred when the drug is used for this purpose. 

Scrima L, Hartman PG, Johnson EH, et al The effects of gamma-hydroxybutyrate on the sleep of narcolepsy patients a double blind study. Sleep 13 479 90, 1990 Series F, Series 1, Cormier Y Effects of enhancing slow-wave sleep by gamma-hydroxybutyrate on obstructive sleep apnea. Am Rev Respir Dis 143 1378-1383, 1992 Shannon M Methylenedioxymethamphetamine (MDMA, ecstasy ). Pediatr Emerg Care 16 377-380, 2000... 

An MRL of 0.1 ppm was derived for intermediate inhalation exposure (15-364 days) to trichloroethylene. This MRL was based on a study by Arito et al. (1994a) in which male JCL-Wistar rats were exposed to 0, 50, 100, or 300 ppm trichloroethylene for 6 weeks, 5 days/week, 8 hours/day. A LOAEL of 50 ppm was observed for decreased wakefulness during exposure, and decreased postexposure heart rate and slow wave sleep. Another study with rats found an increase in sleep-apneic episodes and cardiac arrhythmias after exposure to trichloroethylene (Arito et al. 1993). These results corroborate similar effects observed in humans exposed to trichloroethylene, as described in the previous paragraph, as well as evidence of organic solvent-induced sleep apnea in humans (Edling et al. 1993 Monstad et al. 1987, 1992 Wise et al. 1983). 

Wise MG, Fisher JG, de la Pena AM. 1983. Trichloroethane (TCE) and central sleep apnea a case study. 

Effects noted in study and corresponding doses Decreased post-exposure heart rate and slow wave sleep were observed at 50 ppm (less serious LOAEL). Decreased wakefiilness was observed during the exposures. Disturbed heart rates and sleep patterns (sleep apnea) have been seen in human exposures to organic solvents as well. 

PCP is usually smoked on "Sherman" or "More" cigarettes that have thick brown wrappers that absorb PCP liquid and still allow the cigarette to be smoked. Ingestion of partially smoked PCP cigarettes can result in severe toxicity. About one hour from ingestion of such a cigarette, seizures may suddenly occur, followed by coma, apnea, and hyperthermia. 

Coma. Patients with PCP-induced coma are unresponsive to stimuli, are nonverbal, and have closed eyes. Some patients may have no other findings. Others may have any of the motor and autonomic signs and disturbances of vital signs listed above. A triad of coma-apnea-seizures occurs in this group. 

Systemic lupus erythematosus Scleroderma Sleep apnea Drugs ... 

Side effects associated with benzodiazepines in PD patients are similar to those observed in other disorders. Sedation, fatigue, and cognitive impairment are the most commonly reported side effects.49 Benzodiazepines should be avoided in patients with current substance abuse, a history of such, dependence, or sleep apnea. Additionally, caution should be used in older adults because they have more pronounced psychomotor and cognitive effects. 

Describe the mechanisms of the sleep disorders covered in this chapter, including insomnia, narcolepsy, restless-legs syndrome, obstructive sleep apnea, and parasomnias. 

The main therapy for obstructive sleep apnea is nasal continuous positive airway pressure (CPAP) therapy because of its effectiveness. 

Obstructive sleep apnea (OSA) is a common disorder that is often unrecognized, affecting 4% of middle-aged white men and 2% of middle-aged white women.15 In women, the frequency of OSA increases after menopause. OSA is as common or more common in African Americans and less common in Asian... 

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