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  • Pacu Tylenol Presentation

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    Stanford Anesthesia
    44 Ansichten10 Seiten
    Acetaminophen (N-acetyl-paminophenol), aka paracetamol, has been utilized internationally for more than century Originally synthesized in 1878, not widely used in US until 1950's now one of the most widely used analgesic and anti-pyretics effects. Unlike NSAIDS it is not a peripheral COX inhibitor (which helps its safety profile) IV tylenol achieves a higher peak concentration (C max

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    Acetaminophen (N-acetyl-paminophenol), aka paracetamol, has been utilized internationally for more than century Originally synthesized in 1878, not widely used in US until 1950's now one of the most widely used analgesic and anti-pyretics effects. Unlike NSAIDS it is not a peripheral COX inhibitor (which helps its safety profile) IV tylenol achieves a higher peak concentration (C max

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    Attribution Non-Commercial (BY-NC)
    Als PDF, TXT herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    44 Ansichten10 Seiten

    Pacu Tylenol Presentation

    Hochgeladen von

    Stanford Anesthesia
    Acetaminophen (N-acetyl-paminophenol), aka paracetamol, has been utilized internationally for more than century Originally synthesized in 1878, not widely used in US until 1950's now one of the most widely used analgesic and anti-pyretics effects. Unlike NSAIDS it is not a peripheral COX inhibitor (which helps its safety profile) IV tylenol achieves a higher peak concentration (C max

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Als PDF, TXT herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    von 10

    AcetaminopheninAcutePain Management

    ChrisPainter 12/28/12 PACU

    ALittleBitofHistory
    Acetaminophen(Nacetylp aminophenol),aka paracetamol,hasbeen utilizedinternationallyfor morethancentury Originallysynthesizedin 1878,notwidelyusedinUS until1950s Nowoneofthemostwidely usedanalgesicandanti pyretics
    Amongfirstlinechoicein pediatricpopulations

    Formulations
    Originallyadministeredviaenteral route,now availableforIVadministration
    Perfalgan Europeanformulationavailablesince 2001 Ofirmev USformulationapprovedbyFDAin Novemberof2010.
    FDAApprovalFor
    Managementofmildtomoderatepain Managementofmoderatetoseverepainwithadjunctive opioid analgesics Reductionoffeverinadultsandchildren

    WhatIsIt,andHowtheHeckdoesit Work?
    Acetaminophenhasanalgesicandantipyretics effects
    Exactmechanismsstillnotcompletedknown
    ThoughttoinhibitsynthesisofprostaglandinsinCNS andperipherallyblockpainimpulsegeneration
    UnlikeNSAIDSitisNOTaperipheralCOXinhibitor(Which helpsitssafetyprofile) COX2inhibitionofNSAIDShelpswithpain,COX1 inhibitionsleadstoundesiredsideeffectsw/bleedingand GIandRenalramifications Alsothoughttohaveserotonergic (5HT)andcannaboid agonism

    WhyIVRouteisSoImportant
    Itallcomesdowntopeak concentrationsandtiming
    IVtylenol achievesaHIGHERpeak concentration(Cmax)inaquicker fashion(Tmax)
    ItalsoachieveswithLESSvariability comparedtooral/rectalroutes Bypasses1st metabolismofliverthereby makingmoredrugavailableallthewhile reducingpotentialforhepatotoxicity

    AbletoreachahigherCmaxbyendof infusion(approx15mins)vs alower Cmaxseeninequivalentdosesof oral/rectalin45minutes


    Canbeasmuchas70%peak concentrationinCNS

    SafetyFirst
    Despitehigherpeakconcentrationsstillhassamesafetyprofile as enteral tylenol anddosingisexactlythesame.
    Possiblyevensafer asliverisnoteexposedtothe1st passmetabolism seenwithoraladministration
    Canreduceinitialhepaticexposure~twofold

    Threemainpathsformetabolisminliver
    Conjugationwithglucuronide Conjugationwithsulfate Oxidationwithp450

    DoesItActuallyWork?
    StudybyourownDr.Macario reviewingthe clinicaltrailswithIVAcetaminophen
    16articles(prospective randomizedcontroltrials) comparingIVacetaminophentoplacebooranactive comparator
    12or14trailsinvolvingIVTylenolvs Placeboshowedpts havingimprovedanalgesiaw/10ofthose14demonstrating LOWERopioid consumptionorlongertimeintervalto1st rescue comparedtothosewithoutIVtylenol AlsoshowedthatIVtylenol showedsimilaranalgesiain relationstoactivecomparator:Parecoxib,metamizol, ibuprofen

    Dosing

    InSummary
    IVtylenol isanexcellentanalgesicwithgreat effectsinmultimodalanalgesiahelpingtowork synergisticallywithotheragentsallthewhile helpingtoreduceopioid consumptioninthe acutepainsettinghelpingtominimizethe undesiredsideeffectsofsingleagenttherapies Itisverysafeintheappropriatepatient populationandtheliteraturesupportsthatitis aneffectiveanalgesictouseintheperioperative period.

    References
    AlexMacario,MikeRoyal.ALiteratureReviewof RandomizedClinicalTrailsofIntravenousAcetaminophen forAcutePostOperativePain.PainPratice.Vol 11(3)2011. 290296 PaulWhite.TheChangingRoleofNonOpioid Analgesic TechniquesintheManagementofPostoperativePain. AnesthesiaandAnalgesia.2005Vol 101:S5S22 Pasero etal.TheRoleofIntravenousAcetaminophenin AcutePainManagement.PainManagament Nursing.2012 Vol 13(2).107124 Buvanendran etal.MultimodalAnalgesiaforControlling AcutePostoperativePain.CurrentOpinionin Anesthesiology.Vol 22(5).2009,588593

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