Asunto(s)
Anticonvulsivantes/uso terapéutico , Lorazepam/uso terapéutico , Paraldehído/uso terapéutico , Convulsiones/tratamiento farmacológico , Administración Intranasal , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/efectos adversos , Niño , Preescolar , Almacenaje de Medicamentos , Servicios Médicos de Urgencia , Humanos , Lactante , Inyecciones Intramusculares , Lorazepam/administración & dosificación , Lorazepam/efectos adversos , Malaui , Paraldehído/administración & dosificación , Paraldehído/efectos adversos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Sedation is often required to achieve immobilisation of small children during radiotherapy to avoid irradiation of normal tissues during the course of treatment. At the University College Hospital, Ibadan radiotherapists provide sedation for such patients with administration of parenteral and/or oral promethazine, diazepam, chlorpromazine and paraldehyde. This retrospective review of 84 children aged 1 month to 6 years who received sedation for radiotherapy over a period of twenty-one to twenty-eight days showed that 48% had complications. These included injection cellulitis (85.3%), injection abscess (4.87%), paresis of the lower limb (7.3%), aspiration pneumonia (2.4%). Anaesthetists in developing countries should be encouraged to extend their expertise in caring and resuscitation of sedated or unconscious patients to the radiotherapy unit. This will allow for the use of a wider variety of sedative agents and better monitoring as well as minimise or eradicate complications.
Asunto(s)
Antieméticos/efectos adversos , Clorpromazina/efectos adversos , Sedación Consciente/efectos adversos , Diazepam/efectos adversos , Hipnóticos y Sedantes/efectos adversos , Neoplasias/radioterapia , Paraldehído/efectos adversos , Prometazina/efectos adversos , Absceso/inducido químicamente , Celulitis (Flemón)/inducido químicamente , Niño , Preescolar , Sedación Consciente/métodos , Quimioterapia Combinada , Femenino , Humanos , Lactante , Masculino , Paresia/inducido químicamente , Neumonía por Aspiración/inducido químicamente , Estudios RetrospectivosRESUMEN
Paraldehyde is used in the treatment of status epilepticus, alcohol withdrawal, and delirium tremens. Because it is a solvent, concerns have been raised about infusing it through plastic intravenous tubing sets. In a three-phase study, 4% paraldehyde in 5% dextrose solution was analyzed over 24 hours for photodegradation, adsorption to polyvinylchloride- (PVC) and polyethylene- (PE) lined intravenous tubing, and the presence of di(2-ethylhexyl) phthalate (DEHP). Paraldehyde and DEHP samples were quantified by gas chromatography, and DEHP was confirmed by mass spectral analysis. On exposure to light for 24 hours, the concentration of paraldehyde decreased from 100 to 97%. This decrease is statistically significant but clinically insignificant. A 24-hour continuous infusion of paraldehyde through the two types of tubing revealed a decrease in concentration attributable to adsorption of 4% with PE and 13% with PVC tubing at 2 hours. In addition, there was no appreciable leaching of DEHP over 24 hours with either type of tubing. Concerns about paraldehyde's light instability and effects on tubing integrity appear to be unwarranted with commercially available intravenous administration sets.
Asunto(s)
Cateterismo , Dietilhexil Ftalato/análisis , Paraldehído/efectos adversos , Ácidos Ftálicos/análisis , Cromatografía de Gases , Luz/efectos adversos , Espectrometría de Masas , Paraldehído/análisis , Paraldehído/efectos de la radiación , Cloruro de Polivinilo/análisisRESUMEN
Intravenous (IV) diazepam or phenobarbital is generally accepted as the initial treatment of choice for status epilepticus in children. The risk of severe respiratory depression with either drug is a major problem, particularly in emergency centers that do not have appropriate equipment or personnel for rapid endotracheal intubation of infants. While some pediatric centers are not reluctant to recommend paraldehyde for secondary therapy in status epilepticus, most texts and publications recommend it only as a last resort because of reported complications. We investigated the benefits and complications from varied dosing regimens in 16 trials. The results indicated no significant complications in patients who did not receive an initial IV bolus. Even though treatment with phenobarbital or diazepam and phenytoin sodium had failed, 37% had a good therapeutic response.
Asunto(s)
Paraldehído/uso terapéutico , Estado Epiléptico/tratamiento farmacológico , Adolescente , Niño , Preescolar , Electroencefalografía , Humanos , Lactante , Recién Nacido , Paraldehído/administración & dosificación , Paraldehído/efectos adversos , Paraldehído/sangre , Insuficiencia Respiratoria/inducido químicamente , Estado Epiléptico/fisiopatologíaAsunto(s)
Clormetiazol/uso terapéutico , Lidocaína/uso terapéutico , Paraldehído/uso terapéutico , Estado Epiléptico/tratamiento farmacológico , Clormetiazol/efectos adversos , Clormetiazol/metabolismo , Humanos , Lidocaína/efectos adversos , Lidocaína/metabolismo , Paraldehído/efectos adversos , Paraldehído/metabolismoAsunto(s)
Paraldehído/efectos adversos , Edema Pulmonar/inducido químicamente , Anciano , Delirio por Abstinencia Alcohólica/tratamiento farmacológico , Clordiazepóxido/uso terapéutico , Humanos , Inyecciones Intramusculares , Inyecciones Intravenosas , Masculino , Paraldehído/administración & dosificación , Paraldehído/uso terapéutico , Edema Pulmonar/terapia , Respiración ArtificialRESUMEN
A 2-month-old girl survived a lethal serum level of paraldehyde after being given the drug intravenously (IV) for status epilepticus. On the basis of known pharmacokinetic data in man, a slow IV infusion, over a period of five minutes, of 200 mg/kg of paraldehyde followed by a drip of 20 mg/kg/hr should result in safe, rapid control of status epilepticus when first-line anticonvulsant drugs have failed. The paraldehyde should be diluted to a 10% solution with 5% dextrose water.
Asunto(s)
Paraldehído/efectos adversos , Estado Epiléptico/tratamiento farmacológico , Femenino , Humanos , Lactante , Infusiones Parenterales , Paraldehído/administración & dosificación , Paraldehído/sangreAsunto(s)
Delirio por Abstinencia Alcohólica/complicaciones , Paraldehído/efectos adversos , Proctitis/diagnóstico por imagen , Psicosis Alcohólicas/complicaciones , Constricción Patológica/patología , Diagnóstico Diferencial , Enema/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Proctitis/inducido químicamente , Proctitis/complicaciones , Radiografía , Recto/patologíaAsunto(s)
Enfermedades del Recién Nacido/tratamiento farmacológico , Paraldehído/efectos adversos , Tromboflebitis/inducido químicamente , Trombosis/inducido químicamente , Arterias , Humanos , Recién Nacido , Enfermedades del Recién Nacido/inducido químicamente , Inyecciones Intraarteriales/efectos adversos , Masculino , Paraldehído/administración & dosificación , Convulsiones/tratamiento farmacológico , Arterias UmbilicalesAsunto(s)
Paraldehído/administración & dosificación , Jeringas , Niño , Humanos , Paraldehído/efectos adversos , PlásticosRESUMEN
Clinical and roentgenorgraphic evidence of pulmonary edema developed following the intravenous administration of paraldehyde to a child. Experimental and clinical evidence indicate that administration of undiluted paraldehyde intravenously is hazardous.
Asunto(s)
Tos/inducido químicamente , Cianosis/inducido químicamente , Hipotensión/inducido químicamente , Paraldehído/efectos adversos , Preescolar , Femenino , Humanos , Inyecciones Intravenosas , Paraldehído/administración & dosificación , Edema Pulmonar/inducido químicamenteRESUMEN
Thirty-four patients with severe delirium tremens were allocated randomly to treatment with paraldehyde (10 ml rectally very 30 minutes) or diazepam (10 mg then 5 mg intravenously every 5 minutes) until they were calm but awake. Diazepam-treated patients became calm in one half the time needed to calm patients with paraldehyde. Half of the patients had delirium tremens in association with pneumonia, pancreatitis, or alcoholic hepatitis; these patients required twice as much paraldehyde or diazepam for initial calming as patients with delirium tremens alone. Maintenance of a calm state was accomplished easily with either diazepam, intramuscularly, or paraldehyde, rectally. Adverse reactions occurred in nine patients, all of whom had been treated with paraldehyde; these patients had greater degrees of fever, tachypnea, and tachycardia and required three times longer for initial calming than patients without adverse reactions. Diazepam given under this regimen is a safe and effective sedative for management of combative patients with severe delirium tremens.