ㄟ... 小弟不才, 谨把急诊的观点贴出 (疼痛是急诊的重要议题... 美国统计60%的急诊求诊病人, 因为疼痛就诊!) 节录自急诊教科书p.259, Tintinalli: Emergency Medicine, 6th edition, <<American College of Emergency Physicians>> Meperidine was once the mainstay of pain management in EDs. Meperidine should no longer be routinely used for acute pain management, for several reasons: (1) it is the lowest potency opioid and, as a result, often is underdosed; potency是opioids最低的, 常常剂量过轻 (2) normeperidine, the metabolite of meperidine, has been shown to cause central nervous system toxicity in patients with compromised renal function or those taking monoamine oxidase inhibitors; Demerol的代谢物, normeperidine, 在肾功能不好或者同时服用MAO inhibitors 的病人, 会显现出他的中枢神经毒性 (3) normeperidine can produce prolonged states of sedation (up to 48 h in rare cases); 会造成延长时间的镇定效果 (4) meperidine is reported to produce more euphoria and may have an increased risk for addiction when compared with other opioids. 会造成比较多的euphoria, 而产生比较高的成瘾机会 另外, 另一个更大本的教科书Rosen, 会有更多的叙述不过就不再列举了 美国甚至已经有许多急诊已经不再使用demerol 急诊止痛的drug of choice其实还是morphine, 不是keto或者panadol 只是台湾医风/民风还尚未习惯 ============== 另外一提, 急诊的观点而言, 为了顺利治疗动作的镇定麻醉 (procedural sedation and anesthesia, PSA) 首选短效型benzodiazepine 相较於外科系喜爱使用propoful... 急诊的standpoint主要之一也是 万一造成呼吸抑制可以用flumazenil来马上reverse Propoful (p.278) Amnesia, however, is not reliably produced in doses used for sedation. (propoful的amnesia效果较无法预测) The drug possesses antiemetic properties. Propofol produces significant cardiovascular depression, with dose-related declines in systolic blood pressure of up to 25 to 40 percent when given in induction doses. This effect is more pronounced in those with impaired hemodynamic status and in the elderly.(propoful降压效果明显) The use of propofol for ED PSA is controversial, and its use outside the operating room by nonanesthesia personnel may be restricted by hospital policy. (在OR里面用比较安全) Limited studies using propofol for ED PSA in children and adults have found a rapid onset of sedation, rapid recovery, and high patient and physician satisfaction scores. (infusion一停掉就会很快醒来, 病人/医师满意度高) In doses usually used for PSA, however, analgesic and amnestic agents may be required, which may result in hypoventilation and potentiate the already significant hemodynamic effects of propofol. (较不稳定的病人, 使用propoful较可能会让呼吸跟循环同受到抑制) The research agenda and issues surrounding propofol use by the emergency physician have been delineated. (急诊的场景不常使用啦!!) --

※ 发信站: 批踢踢实业坊(ptt.cc) ※ 编辑: oneders 来自: 118.166.197.58 (11/25 23:15)