Clinical Tag's Archives
Synopsis of Important Principles
- The main aim of anaesthesia is the prevention of pain during surgery and at other times.
- Anaesthesia involves a balanced approach, in which the individual patient’s psyche and pathophysiology are taken into account and drugs are used to modify and control any aspect as required.
- The decision to use a particular drug or technique must be made after careful consideration of the pathophysiological features of the individual case and how these may affect the pharmacokinetic handling and tissue response to the drugs available.
- Any associated disease or pathophysiological abnormality should wherever possible be treated or corrected before operation, and potentially dangerous physiological disturbances avoided during and after anaesthesia.
- Anaesthetic drugs are relatively non-toxic but there are some important effects. Halothane is occasionally associated with hepatitis and methoxyflurane with kidney damage. Malignant hyperpyrexia, the aetiology of which is uncertain, is a rare but often fatal condition which can be triggered off by several anaesthetic drugs in genetically susceptible individuals.
Anaesthesia, Chronic Pain, Clinical, Disease, Dosage, Effect, Electrolyte, Kidney, Method, Oral, Pain, Respiratory, Risk, Severe, Surgery, Surgical, Therapy, Treatment
Haemodialysis, peritoneal dialysis, haemoperfusion, exchange transfusion and forced diuresis have all been used in attempts to increase the rate of removal of drugs and poisons. However, the amount of active drug removed is often disappointingly small, and the indications for the use of such measures is very limited.
Nevertheless, poisoned patients are often unnecessarily subjected to these potentially harmful measures, and the literature is full of anecdotal accounts of miraculous recovery attributed to such treatment (Winchester et al. 1977). Properly controlled clinical trials are difficult to carry out, and very few have been published. With the possible exception of forced alkaline diuresis for poisoning with salicylate and long acting barbiturates such as phenobarbitone, none of these methods for enhancement of drug removal has ever been shown to reduce morbidity or mortality in poisoned patients (Todd 1984).
Indeed, some studies suggest the opposite result. This is not to say that such measures are never necessary, or indeed sometimes life saving, but a more critical appraisal of their role is required.
Absorption, Acidic, Alkaline, Analytical, Bentonite, Chemical, Clinical, Dialysis, Dose, Fraction, Method, Paracetamol, Poison, Recovery, Therapeutic, Toxic, Treatment, Trial
Therapeutic drug monitoring is based upon the collaboration between a health care provider (clinician, pharmacist, nurse) responsible for making quantitative and qualitative decisions about drug treatment and the clinical laboratory providing analytical services for the measurement of drug concentrations. The information provided by a drug concentration measurement is generally greater than for other substances measured by the laboratory.
This is because, unlike say sodium or glucose, the intake of a drug is quite well known and the processes of distribution and elimination are usually very simple and not under the control of a multitude of homeostatic controlling reflexes.
Analytical, Clinical, Collaboration, Diagnose, Dosage, Dose, Drug, Figures, Forecasting, Glucose, Interval, Laboratory, Measurement, Multitude, Precision, Provider, Quantitative, Rational, Reference, Serum, Substance, Substitute, Therapeutic, Treatment, Value
