Neuroleptanalgesia
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Neuroleptanalgesia
The word neuroleptic originates from the Greek word lepsis ("seizure"). Antipsychotics ( neuroleptics or tranquilizers) were investigated by the anesthesiologists De Castro and Mundeleer who coined the term neuroleptanalgesia, an anesthetic process that involves combining a major antipsychotic/neuroleptic or tranquilizer with a potent opioid analgesic to produce a detached, pain-free state. This technique was widely used from the 1960s onwards, initially using a combination of phenoperidine and haloperidol, which was subsequently replaced in the early 1980s by a combination of fentanyl and droperidol. Efforts were also made to develop compounds which combined both types of activity in a single molecule. Neuroleptanalgesia results in amnesia among some patients, but not all. The technique has become less popular with the advent of more modern procedural sedation drug combinations, though it is still rarely used today as a combination of 2.5 mg droperidol and 50 μg (micrograms) of fen ...
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Antipsychotic
Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of Treatment-resistant depression, treatment-resistant major depressive disorder. The use of antipsychotics may result in many unwanted side effects such as Extrapyramidal symptoms, involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce List of long term side effects of antipsychotics, adverse effects such as tardive dyskinesia, tardive dystonia, Akathisia, tardive akathisia, and brain tissue volume reduction. The long term use of antipsychotics ...
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Tranquilizer
A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are central nervous system (CNS) depressants and interact with brain activity, causing its deceleration. Various kinds of sedatives can be distinguished, but the majority of them affect the neurotransmitter gamma-aminobutyric acid (GABA). Most sedatives produce relaxing effects by increasing GABA activity. This group is related to hypnotics. The term ''sedative'' describes drugs that serve to calm or relieve anxiety, whereas the term ''hypnotic'' describes drugs whose main purpose is to initiate, sustain, or lengthen sleep. Because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects (ranging from anxiolysis to loss of consciousness), they are often referred to collectively as ''sedative–hypnotic'' drugs. Terminology There is some overlap between the terms "sedative" and "hypnotic". Advances in pharmacolo ...
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Opioid
Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, including analgesic, pain relief. The terms "opioid" and "opiate" are sometimes used interchangeably, but the term "opioid" is used to designate all substances, both natural and synthetic, that bind to opioid receptors in the brain. Opiates are alkaloid compounds naturally found in the opium poppy plant ''Papaver somniferum''. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, and Cold medicine, suppressing cough. The opioid receptor antagonist naloxone is used to reverse opioid overdose. Extremely potent opioids such as carfentanil are approved only for Veterinary medicine, veterinary use. Opioids are also frequently use ...
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Analgesic
An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in some instances eliminate, sensation, although analgesia and anesthesia are neurophysiologically overlapping and thus various drugs have both analgesic and anesthetic effects. Analgesic choice is also determined by the type of pain: For neuropathic pain, recent research has suggested that classes of drugs that are not normally considered analgesics, such as tricyclic antidepressants and anticonvulsants may be considered as an alternative. Various analgesics, such as many NSAIDs, are available over the counter in most countries, whereas various others are prescription drugs owing to the substantial risks and high chances of overdose, misuse, and addiction in the absence of medical supervision. Etymology The word ''analgesic'' derive ...
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Phenoperidine
Phenoperidine (Operidine or Lealgin), is an opioid analgesic which is structurally related to pethidine and is used clinically as a general anesthetic. Medical use Phenoperidine is an opioid pain killer—a narcotic analgesic. Pharmacology It is a derivative of isonipecotic acid, like pethidine, and is metabolized in part to norpethidine. Its potency range is due to method of ingestion. figure 20–80 times as potent as pethidine as an analgesic. The greatly increased potency essentially eliminates the toxic effects of norpethidine accumulation which are seen when pethidine is administered in high doses or for long periods of time. History and Synthesis Phenoperidine was first synthesized in 1957 by Paul Janssen, of the company now known as Janssen Pharmaceutica, who was seeking better opioid pain-killers. His two prototype drugs were methadone and pethidine, each which had been invented in 1930s by Otto Eisleb, who worked for IG Farben. His initial work starting with methado ...
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Haloperidol
Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychosis, and hallucinations from alcohol withdrawal. It may be used by mouth or injection into a muscle or a vein. Haloperidol typically works within 30 to 60 minutes. A long-acting formulation may be used as an injection every four weeks for people with schizophrenia or related illnesses, who either forget or refuse to take the medication by mouth. Haloperidol may result in movement disorders such as tardive dyskinesia, and akathisia, both of which may be permanent. Neuroleptic malignant syndrome and QT interval prolongation may occur, the latter particularly with IV administration. In older people with psychosis due to dementia it results in an increased risk of death. When taken during pregnancy it may result in problems in the infant. I ...
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Fentanyl
Fentanyl is a highly potent synthetic piperidine opioid primarily used as an analgesic (pain medication). It is 30 to 50 times more Potency (pharmacology), potent than heroin and 50 to 100 times more potent than morphine. Its primary Medicine, clinical utility is in pain management for cancer patients and those recovering from painful surgeries. Fentanyl is also used as a sedative. Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose. Fentanyl works by activating μ-opioid receptors. Fentanyl is sold under the brand names Actiq, Duragesic, and Sublimaze, among others. Pharmaceutical fentanyl's adverse effects are similar to those of other opioids and narcotics including addiction, confusion, hypoventilation, respiratory depression (which, if extensive and untreated, may lead to respiratory arrest), drowsiness, nausea, visual disturbances, dyskinesia, hallucinations, delirium, a subset of the latte ...
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Droperidol
Droperidol (Inapsine, Droleptan, Dridol, Xomolix, Innovar fentanyl.html" ;"title="ombination with fentanyl">ombination with fentanyl is an antidopaminergic medication, drug used as an antiemetic (that is, to prevent or treat nausea) and as an antipsychotic. Droperidol is also often used as a rapid sedative in intensive care medicine, intensive-care treatment, and where "agitation aggression or violent behavior" are present. History Discovered at Janssen Pharmaceutica in 1961, droperidol is a butyrophenone which acts as a potent D2 (dopamine receptor) antagonist with some histamine and serotonin antagonist activity. Medical use It has a central antiemetic action and effectively prevents postoperative nausea and vomiting in adults using doses as low as 0.625 mg. For treatment of nausea and vomiting, droperidol and ondansetron are equally effective; droperidol is more effective than metoclopramide. It has also been used as an antipsychotic in doses ranging from 5 to 10 ...
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Amnesia
Amnesia is a deficit in memory caused by brain damage or brain diseases,Gazzaniga, M., Ivry, R., & Mangun, G. (2009) Cognitive Neuroscience: The biology of the mind. New York: W.W. Norton & Company. but it can also be temporarily caused by the use of various sedative and hypnotic drugs. The memory can be either wholly or partially lost due to the extent of damage that is caused. There are two main types of amnesia: * Retrograde amnesia is the inability to remember information that was acquired before a particular date, usually the date of an accident or operation. In some cases, the memory loss can extend back decades, while in other cases, people may lose only a few months of memory. * Anterograde amnesia is the inability to transfer new information from the short-term store into the long-term store. People with anterograde amnesia cannot remember things for long periods of time. These two types are not mutually exclusive; both can also occur simultaneously. Case stud ...
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Procedural Sedation
Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decreased level of consciousness while maintaining the patient's ability to breathe on their own. PSA is commonly used in the emergency department, in addition to the operating room. While PSA is considered safe and has low rates of complication, it is important to conduct a pre-procedural assessment, determine any contraindications to PSA, choose the most appropriate sedative agent, and monitor the patient for potential complications both during and after the procedure. Medical uses This technique is often used in the emergency department for the performance of painful or uncomfortable procedures. Common purposes include: * laceration repair * setting fractures * draining abscesses * reducing Joint dislocation, dislocations * performing endo ...
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Anesthetics
An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two broad classes: general anesthetics, which result in a reversible loss of consciousness, and local anesthetics, which cause a reversible loss of sensation for a limited region of the body without necessarily affecting consciousness. A wide variety of drugs are used in modern anesthetic practice. Many are rarely used outside anesthesiology, but others are used commonly in various fields of healthcare. Combinations of anesthetics are sometimes used for their synergistic and additive therapeutic effects. Adverse effects, however, may also be increased. Anesthetics are distinct from analgesics, which block only sensation of painful stimuli. Analgesics are typically used in conjunction with anesthetics to control pre-, intra-, and postoperat ...
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Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, propofol, etomidate, ketamine, pentobarbital, lorazepam and midazolam. Medical uses Sedation is typically used in minor surgical procedures such as endoscopy, vasectomy, or dentistry and for reconstructive surgery, some cosmetic surgeries, removal of wisdom teeth, or for high-anxiety patients. Sedation methods in dentistry include inhalation sedation (using nitrous oxide), oral sedation, and intravenous (IV) sedation. Inhalation sedation is also sometimes referred to as "relative analgesia". Sedation is also used extensively in the intensive care unit so that patients who are being mechanical ventilation, ventilated tolerate having an endotracheal tube in their vertebrate trachea, trachea. It can also be used during a long term brain EEG ...
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