Reduction of Shoulder Dislocation Medication

Updated: Aug 09, 2017
  • Author: Anantha K Mallia, DO, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Anxiolytics, Benzodiazepines

Class Summary

Administration of temazepam immediately before a procedure can decrease the risk of tachycardia and hypertension resulting from anxiety regarding the operation. In the operating room, intravenous (IV) administration of a small dose of midazolam before arterial line insertion can also reduce anxiety, tachycardia, and hypertension.

Temazepam (Restoril)

Temazepam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

Midazolam

Midazolam is a short-acting benzodiazepine with a rapid onset of action.

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Local Anesthetics, Amides

Class Summary

Local anesthetics block the initiation and conduction of nerve impulses. Anesthetics used for the procedure include lidocaine.

Lidocaine and epinephrine (Xylocaine MPF with Epinephrine)

Lidocaine is an amide local anesthetic used in 1% concentration. It inhibits depolarization of type C sensory neurons by blocking sodium channels.

Epinephrine prolongs its effect and enhances hemostasis (maximum epinephrine dose, 4.5-7 mg/kg).

Mepivacaine (Polocaine MPF, Prilocaine, Carbocaine)

Mepivacaine 2-3% prevents the generation and conduction of nerve impulses. For longer surgical anesthesia, up to 3-4 hours, 1:400,000 epinephrine is added to the solution. Epinephrine prolongs the duration of the anesthetic effects from mepivacaine by causing vasoconstriction of the blood vessels surrounding the nerve axons. The block completely resolves about 3-4 hours later.

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Anesthetic Agents

Class Summary

After standard monitoring equipment is attached and peripheral venous access achieved but before the arterial line is inserted, the midazolam dose is administered. Before placement of the arterial line, it should be ensured that a radial artery graft will not be used for coronary artery bypass grafting.

Propofol (Diprivan)

Propofol is a phenolic compound unrelated to other types of anticonvulsants. It has general anesthetic properties when administered intravenously. Intravenous propofol produces rapid hypnosis, usually within 40 seconds. The effects are reversed within 30 minutes following the discontinuation of infusion. Propofol has also been shown to have anticonvulsant properties.

Etomidate (Amidate)

Amidate is a nonbarbiturate imidazole compound with sedative properties. It is short acting and has a rapid onset of action; the duration of action is dose dependent (15-30 min). Its most useful feature as an induction agent is that it produces deep sedation while causing minimal cardiovascular effects.

The major application of etomidate is induction for endotracheal intubation, particularly in patients with, or at risk for, hemodynamic compromise. Etomidate has been shown to depress adrenal cortical function; however, this effect is not significant clinically during short-term administration. Since the drug is mixed in propylene glycol, continuous infusion is not recommended.

Thiopental

Thiopental is a short-acting barbiturate sedative-hypnotic with rapid onset and a duration of action of 5-20 minutes. Like methohexital, it is most commonly used as an induction agent for intubation. To use thiopental as a sedative, titrate in dosage increments of 25 mg (adjust to lower dose in children).

Isoflurane (Forane, Terrell)

Isoflurane is an inhalation anesthetic. It may have a myocardial protective effect and therefore is especially useful in off-pump surgery. Isoflurane potentiates the effects of muscle relaxants. Small doses of muscle relaxants can achieve complete paralysis when administered concomitantly with isoflurane.

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Opioid Analgesics

Class Summary

Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties that are beneficial for patients who experience pain.

Fentanyl citrate (Duragesic, Abstral, Actiq, Fentora, Onsolis)

Fentanyl citrate is a synthetic opioid that has 75-200 times more potency and a much shorter half-life than morphine sulfate. It has fewer hypotensive effects than morphine and is safer in patients with hyperactive airway disease because of minimal or no associated histamine release. By itself, fentanyl citrate causes little cardiovascular compromise, although the addition of benzodiazepines or other sedatives may result in decreased cardiac output and blood pressure.

Fentanyl citrate is highly lipophilic and protein-bound. Prolonged exposure to it leads to accumulation of the drug in fat and delays the weaning process. Consider continuous infusion because of the medication's short half-life.

Remifentanil (Ultiva)

Remifentanil binds mu-opioid receptors at various sites within the CNS.

Morphine sulfate (Duramorph, Astramorph, MS Contin, Avinza, Kadian)

Morphine sulfate is the drug of choice for analgesia, owing to its reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Various intravenous doses are used; it is commonly titrated until the desired effect is obtained.

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