Heavy sedation

In rats, the LDso for 4 hours was 4420 ppm effects included irritation of mucous membranes, increased respiration, incoordination, staggering gait, weakness, partial skeletal muscle paralysis, light to severe cyanosis, and mild to heavy sedation. ... 

Pharmacodynamics, antipsychotics also differ in their pharmacodynamics, i.e. their pharmacological and clinical profiles of action. A rough distinction is made between highly sedative, hypnotic antipsychotics (e.g. clopenthixol, levomepromazine) and other products with weaker initial sedative action (e.g. fluphenazine and haloperidol). Sedative antipsychotics are prescribed for states of major unrest, often combined with insomnia, whereas the less sedative antipsychotics are preferred for patients suffering from delusions and hallucinations but in whom heavy sedation during daytime is undesirable. 

Iatrogenic Reactions broadly refer to any adverse reactions that are unintentionally produced by physicians in their patients. For example, one of the side effects of many antihistaminic preparations (Hj antagonists) such as ethanolamine derivatives (prototype diphenhydramine) is heavy sedation. Although sedation may be desirable for some patients, it may interfere with daytime activities, and this needs to be considered when prescribing such medications. Other antihistaminic preparations (also 11 antagonists) such as piperidine derivatives (prototypes terfenadine or astemizole) have no sedative properties (Figure 3.2). 

Diphenhydramine causes heavy sedation Terfenadine causes no sedation FIGURE 3.2 Terfenadine does not have sedative effects. 

Clonidine (Catapres) is another drug used to treat opiate addiction. It can relieve the anxiety, runny nose, salivation, sweating, abdominal cramps, and muscle aches of opiate withdrawal. Side effects are dry mouth, dizziness, and drowsiness. Clonidine is initially taken at 0.8-1.2 mg a day, maintained for a few days, and then gradually decreased. Combined with the opiate blocker naltrexone, clonidine can allow a more rapid detoxification (the removal of morphine from the body). Detox in a single day can be accomplished by heavy sedation or anesthesia while giving naltrexone to an unconscious addict. This controversial method has not been studied in controlled trials. 

Trazodone has structural similarities with TCAs but probably acts by antagonism of postsynaptic serotonin receptors and presynaptic a-adrenoceptors. It is an option for depressed patients where heavy sedation is required. Trazodone also has the advantages of lacking antimuscarinic effects and being relatively safe in overdose. Males should be warned of the possibility of priapism (painful penile erections), attributable to the drug s blockade of ttj-adrenoceptors. 

Compared to phenytoin, phenobarbital is a relatively safe compound. Rarely, a morbilliform rash occurs. However, in some patients, heavy sedation, reduction in activity, and impairment in cognition may be pronounced. 

An anticonvulsant, primidone is given at an initial dose of 100 to 125 mg/day at bedtime, increasing gradually to a maintenance dose of 125 to 250 mg three times daily. The most frequent side effect of primidone is heavy sedation, which seems to be due to primidone itself and not to its metabolite phenobarbital. Tolerance develops to this sedation within a few days or weeks of continuous administration. 

Thioridazine (50 to 100 mg p.o. t.i.d.) is indicated in psychosis. Thioridazine has potent anticholinergic properties and causes heavy sedation. However, it produces a very low incidence of extrapyramidal reactions such as akathisia, dystonia, parkinsonism, tardive dyskinesia, and neuroleptic malignant syndrome. Thioridazine is metabolized to mesoridazine, which is an active antipsychotic (see Table 19). 

Triflupromazine causes heavy sedation and has potent anticholinergic properties. It causes a moderate degree of extrapyramidal movement disorders such as akathisia, dystonia, Parkinson s disease, tardive dyskinesia, and neuroleptic malignant syndrome. 

Trimipramine exhibits moderate affinity for alphaj-adren-ergic receptors and muscarinic-cholinergic receptors, and a very strong affinity for Hi-histamine receptors. Trimipramine causes heavy sedation, has strong antichofinergic properties, and exhibits a moderate degree of orthostatic hypotension. 

A procedural strategy is then developed and discussed with the team regarding anesthesia type (local, heavy sedation, general), technique, and type of venous approach, and all necessary tools are checked in the cath lab or surgical room. The procedure can fail if a particular tool is missing. The surgeon is informed about the procedure to ensure surgical standby. 

CTC in symptomatic patients is to be considered when colonoscopy can not be completed or carried out this may occur due to mechanical hindrance such as pelvic adhesions, in cases of high risk of perforation as in complicated diverticular disease, when there is an obstruction due to cancer or extracolonic diseases, when the cecum cannot be reached in extreme dolicocolon conditions, or in patients with poor tolerance to colonoscopy in whom heavy sedation may be dangerous (elderly patients or patients with severe co-morbidity). Such indications are similar to those of double contrast barium enema (DCBE) however, CTC has been shown to be both more accurate and better tolerated than DCBE, and should be used preferentially whenever available (Rocket et al. 2005 Taylor et al. 2005 Taylor et al. 2006). Furthermore, in cases of obstructing colonic cancer, CTC is a valuable tool, as it can be conveniently performed at the time of a contrast-enhanced abdominal CT scan for staging purposes to detect synchronous colorectal carcinomas, metas-... 

Recruitment maneuvers are based on the concept that alveolar recruitment occurs throughout a positive-pressure inflation—all the way to the total lung capacity (TLC) (21). In practice, they are performed using sustained inflations of 30-40 cmH20 for up to two minutes (21,22). An alternative approach is to use frequent sigh breaths that briefly take the lung to near TLC (22,23). The duration of recruitment depends on an appropriate setting of PEEP to prevent subsequent de-recruitment. Recruitment maneuvers may require heavy sedation to perform, and transient hypotension occasionally develops. 

Opioids are widely used in medicine, particularly in anaesthesia for the control of pain and in producing heavy sedation. They have considerable CNS effects and this has led to their being regarded as potential CW agents in respect of their knock-down capabilities. The actions offentanyl compounds which may be active by inhalation have been particularly considered. Some of these compounds have an action that is almost instantaneous, causing incapacitation. Opioids act centrally... 

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