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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Analgesia and Pain Management01:25

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
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Inhalational Anesthetics: Overview01:20

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Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
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Intranasal Analgesia in Preterm and Term Neonates.

A Perri1,2, S Fattore3, A Sbordone3

  • 1Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy. Alessandro.perri@policlinicogemelli.it.

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This summary is machine-generated.

Intranasal drug delivery offers advantages for neonatal pain management. This review guides the use of intranasal medications like fentanyl, midazolam, ketamine, and dexmedetomidine in infants, particularly preterm neonates.

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Area of Science:

  • Neonatal care
  • Pharmacology
  • Pain management

Background:

  • Neonatal pain management is critical due to infants' immature antalgic systems and increased stress responses.
  • Untreated pain in infants is linked to adverse neurodevelopmental outcomes, including poorer cognitive and motor scores.
  • Intranasal drug delivery presents advantages over oral administration, such as faster absorption and avoidance of gastrointestinal effects.

Purpose of the Study:

  • To review evidence on intranasal drug administration for pain management in neonates.
  • To provide a practical guide on dosages and indications for intranasal drugs in the neonatal population.
  • To highlight specific intranasal agents suitable for neonatal pain and sedation.

Main Methods:

  • Literature review of studies on intranasal drug delivery for neonatal pain.
  • Analysis of pharmacokinetics and pharmacodynamics of common analgesics in infants.
  • Synthesis of current evidence on specific intranasal agents for neonatal use.

Main Results:

  • Intranasal fentanyl is a viable option for procedural/palliative pain in preterm infants lacking IV access.
  • Intranasal midazolam is suitable for sedation in term/near-term neonates.
  • Ketamine and dexmedetomidine show promise for specific neonatal sedation and pain management scenarios, with dexmedetomidine well-tolerated in preterm infants.

Conclusions:

  • Intranasal medications offer effective and practical alternatives for neonatal pain and sedation.
  • Specific agents like fentanyl, midazolam, ketamine, and dexmedetomidine have distinct roles in neonatal care.
  • Further research and clinical application of intranasal routes can optimize neonatal pain management strategies.