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Hydromorphone for Moderate Sedation- midterm presentation

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Hi my name is kayla went and i am at the emory university medical imaging program i’m in it rather i mean the administration track and today i’m going to be presenting a presenting an article for pharmacology and it’s my journal article not my article summary like i was supposed to do the first time sorry about that and so let’s get started the objectives that i

Have today we’re going to discuss the article discusses topics purpose its reasoning and its goals we’re going to also and in hydro hydromorphone and sentinels general interest extreme talk about those as well as their adverse events associated with them we’re going to highlight the strange methods so this reasoning and other variables think of them as being how

Well it works for pain as well as how little it causes adverse events and how how how little those events are like you know are they cody or is it just like a little little bit drop their o2 stats like 93 or something um we’re gonna discuss the results in relation to analgesic effectiveness and adverse events as well as potential usefulness for the future then

We’re going to describe the limitations of the study and what may need to be done for you know further and we’re going to conclude the results and finals so here we go so hydromorphone hike for item use during various interviews for radiology procedures pain control and adverse events a case series audit analysis that’s the article that we’re gonna be talking about

The thailand article here my authors are here on the purpose of this article was to examine pain control and adverse events while using hydromorphone which is known as the water in combination with vs. and i all know that pronounced animals like benzodiazepine midazolam we’re gonna call it versatile for the remainder of the study or remainder of the presentation

And insert some reasoning behind this study let’s procedures are being done more procedures are becoming less invasive so they can be done outside of the door and without anesthesia they don’t need general anesthesia and or they don’t be mac anesthesia either so they can they can get bottom of my little sedation meaning summers so there’s been an increase in this

In an additional while the study was to also compare the adverse effects hydromorphone to the ones from signal – warhol it’s an opiate used for indonesia essentially just the big words of pain versus the pain medicine it’s four to eight times stronger than morphine so it has the pain potency so to speak four to eight times higher than one thing on meditation to

Affect about 15 minutes after out of the administration so as soon as it’s put through about 15 minutes later the fixed start taking place on the results they can and usually results in respiratory depression so whether it be you know extreme or just a little less time it results in respiratory depression from the send of the products of the drug and there are no

Known drug specific reactions so using it with versed would be completely fine so if it is also thought be aware of pain and it’s a hundred times the pain focus your energies of potency of morphine so we talked about how important it was four to eight times thick was a hundred times that’s pretty significant he goes into effect almost immediately so we’ve got 50

Minutes compared to just like that so so far simple is title so it would be more effective in stopping the pain right it would be more effective in controlling pain for pain sorry however in large verses it offers the respiratory rate the alveolar ventilation as well as the serious co2 sensitivity and it can lead to a tuile and hypoxia which would be like would

Decrease oh – sats essentially still chest syndrome so it can also lead to stiffen stiff chest syndrome which is a very rare but very serious the very serious reaction from fentanyl this stiff chanting drummers use is when you’re adorable abdominal muscles contract after the administration of signal so your abdominal muscles are contracting the up stiff chest

And so this is a problem and this is the problem that so you know regular nurses not in anesthesia like not crnas or not anesthesiologist or a case that they’re not may be familiar with and therefore i don’t really know how to treat this reaction so fentanyl could potentially be it could become a contraindicated for this reason right here so the methods of the

Patient’s from louisiana state university interns hospital of our department it was a retrospective and consecutive study with procedures from july 31st 2013 excluded these people it’s whether the people under the age of 18 it excluded prisoners people with mental incapacitation and people who have been admitted to the hospital for greater than 30 days all those

People were excluded age 6 the types of procedures term morbidities hydromorphone dose versed doze pretty interpose and the pre interpret and post pain scores of the or associated nausea like and the antiemetic administration having to be used the locks on hydrochloride which is just mark and hypotension when your blood pressure your systolic became less than a

Hundred the hypoxia when your oak susac became less than 93 and pack your mission if the patient’s reactions were too great for the rate of the nurses or the regular team to deal with all of these things were examined and there were variables associated to on the effectiveness of hydromorphone and then patients for groups to determine that we talked about here the

Pain scores the pre-internet close that were determined verbally by nurses with your average paints form what’s your pain scale from one to ten with one being known and ten being the worst and then they also use walls facial pain sports so that was also used maybe during the procedure or if the patient was not cooperate or not talking very much the results so they

Consisted the hundred people consists of 52 min and 48 women the age was not statistically significant so there wasn’t really a whole lot of difference there the peak the brief injured and post procedure pending scores were similar among six except during the abscess strangers so their access training these men experienced the most pain and then highest thanks

For reach was three point five it was posts and then frost me too for a female so that was the most pain experienced after the administration of hydromorphone the adverse events that these that word that came about whom has nausea vomiting one man and three women experienced not even vomiting how just because two more women than men experienced more northern water

Doesn’t mean that it’s your more so feared more specific to it if your woman those are kind of statistically insignificant and then in those places you see the entire medic like finnegan you know i met a medicine to help quit here with your knowledge of any robbery and then happy teaching after we told the houses pattern so this hypertension occurred after one

Patient had a total dialysis catheter put it on the pressure drop to the systolic pressure of lower of three obviously and after two hours after the administration – it’s hard to say we’ll get into the more of the discussion later and then hypoxia after defrosting placement of one patient experience that they went from a to set tune of 94 200 on o2 levels of two

Leaders and then they went to 89 to 91 percent after one hour post procedure and the adverse events continued there were no peppy admissions and there was no dark any given are needed so no patients crashed or had serious events to where they could reverse them otherwise take care of them with more conservative avenues so some of the discovered hydromorphone was

Successful in controlling the patient’s pain they were safely control of four percent of patients either vomit or received nci medes and then what we’re seeing experience hypoxia which would be attributed attributed to the removal of the procedures stimulus so they’re saying that the hypoxia was due to the lack of procedures stimulus once it was over with it was

Worn out after they’re saying that the lack of stimulus kind of attributed to the hypoxia and then they’re untrue they’re also insured if there’s one percent of hypertension that we talked about earlier with the patient when the dialysis catheter they’re unsure if it was due to the hydromorphone or other conditions related to that alyce’s so because it didn’t

Happen until the patient was actually on that houses so they do believe however that it did a tribute to the severity so if their blood pressure was going to drop in dallas anyway the hydromorphone did a tribute to the severity of it and making it worse and then the conservative treatment the certain treatment was for all adverse events there was nothing crazy

They didn’t have the two of anybody they didn’t have to call a code or anything like that everything was a conservative measure and conservative treatment and this is more description so there’s no prior literature be using hydromorphone for these types of for these types of procedures for period procedurally which just means before during and after the procedure

No that can be found but it was primarily used before this variant before the study for just chronic pain that ranged from moderate to severe so it wasn’t really for was it in for moderate sedation there was just more set for chronic pain the use of hydromorphone is expected so with the with some of the things that fit note some of the adverse events that fit

Ball has then if hydromorphone has less adverse events and proves to still be effective then you know had normal may very well be replacing signal the most common oxidation so some limitations which i definitely agree with was this they said they had a small sample size they only had a hundred patients at one hospital so this is very extremely small and then so

This calls them to the representation of the cases but it’s suffering because with the hundred patients you’re not you’re not going to see every single i our procedure so this also led to the historically most painful procedures not being observed so some of our procedures that are less painful were not observed and so therefore they fit and see how everyone

Will defect during those procedures so the results may have been different if that were the case then of course always a retrospective study is lindsay has a liberty nature a prospectors study would be most suitable so that you can examine right in there and then compile data for that you can see as it goes through the entire process so the conclusion there this

Is for supplying the hydromorphone can’t be used as a safe effective energy see for our procedures to determine the efficacy and cost-effectiveness large sizes are needed so essentially there definitely needs to be some more studies going on but in my current workplace we use moderate sedation on every face just about what we use the spittle anniversary kind of

Like weather exactly what they’re comparing hydromorphone to and i think we know we do a pretty good job of you know not having adverse events today and properly some things just you can’t control it happens the patience you don’t know how that bothers you already have you don’t know how they’re gonna react to the procedure or the medication so it simple does have

More adverse events then you know this would be very beneficial to us in seeing that hydromorphone would be more effective and at least more safer so i think there definitely needs to be more study done i would be very interested to further study this and to see if a hundred mormon was actually a lot better than general because then we could make some changes at

Our current place right now and so i know what questions i know you’re nervous i don’t

Transcribed from video
Hydromorphone for Moderate Sedation- midterm presentation By Caleb Wynne