Paediatric Procedural Sedation – Ketamine

Paediatric Procedural Sedation – Ketamine Adapted for the Royal Children’s Hospital Clinical Guidelines – see links.  1. Indications Procedure duration <45mins  LP Plaster Care Venous access Fractures NGT or IDC placement/removal Extraction of FB 2. Risk Assessment Delayed gastric emptying or vomiting Bowel obstruction GORD Significant respiratory disease Upper airway obstruction Airway infection Apnoea Exacerbation of ...

Autonomic Nervous System

Autonomic Organisation Cell bodies of the preganglionic neutrons are located in the intermediolateral (IML) column of the spinal cord and in the motor nuclei of some cranial nerves Preganglionic neutrons are small-diameter, myelinated, relatively slow conducting B fibres Preganglionic axons divide to an average of eight or nine postganaglionic neurons – leading to diffuse autonomic ...

Nitric Oxide

Signalling Mechanisms Metalloproteins NO interacts with metals, especially Fe in heme Major target is soluble guanylyl cyclase (sGC) which is a heme-containing enzyme that generates cGMP from GTP Activation leads to increased intracellular cGMP which activates proteins kinase G (PKG) which phosphorylates a range of proteins This leads to reduced systolic calcium levels and subsequently ...

Anti-Arrhythmic: Class 1C

Drug Name Flecainide Class  Antiarrhythmic: 1C Pharmacodynamics  Potent blocker of Na and K channels with slow unblocking kinetics Does not prolong APD or QT interval Absorption/Administration Distribution Metabolism T1/2 =20 hours Both hepatic and renal Excretion Indications Used only for patients with otherwise normal hearts who have supra ventricular arrhythmias Dose 100-200mg BD Contraindications Notable ...

Anti-Arrhythmics

Subclass, Drug               Mechanism of Action Effects Application Pharmacokinetics Class 1A – Procainamide INa (Primary) and IKr (secondary blockade) Slows conduction velocity Slows pacemaker rate Prolongs AP duration Direct depressant on SA & AV nodes Intermediate kinetics Second line drug for sustained ventricular dysrhythmia associated with MI Oral, IV, IM ...