opioids
Pharmacology
Methylnaltrexone
Methylnaltrexone (Relistor) is a subcutaneous, peripheral μ-opioid receptor antagonist used primarily to offset the detrimental effects of opioids on the gastrointestinal (GI) tract, including constipation and decreased GI motility. Due to its charged, quaternary...
Rishi -
Education
High Dose Fentanyl Induction
The induction of general anesthesia in patients undergoing cardiac surgery is often times different than non-cardiac surgery. At many institutions, these inductions tend to center heavily around high dose opioids due to the hemodynamic...
Rishi -
Medical
Sufentanil
Sufentanil (Sufenta) is the most powerful narcotic (~1000x more potent than morphine) approved for use in humans. In fact, it's so potent and has such a strong affinity for mu-opioid receptors that I routinely...
Rishi -
Medical
Hydromorphone
My opioid of choice in the perioperative and ICU settings is hydromorphone (Dilaudid). This medication is roughly 5-10 times more potent than morphine and comes in intravenous (IV) and oral formulations.
Similar to other narcotics,...
Rishi -
Medical
Remifentanil
Remifentanil (Ultiva) is a potent (~200-300 times more than morphine), short acting, titratable narcotic infusion I use for moderate/deep sedation and maintaining general anesthetics. Unlike many drugs which rely on hepatic and/or renal metabolism,...
Rishi -