Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

13 Elul 5763 - September 10, 2003 | Mordecai Plaut, director Published Weekly









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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

There are possibilities for making painful procedures go easier, and these should be available in all emergency departments. One that is easily administered is nitrous oxide or laughing gas. It is a amnesic, meaning the patient may not remember what occurred during the time he received the gas, and it is analgesic, meaning it controls pain. However, its effects are not that strong and it often causes vomiting if used for more than a few minutes.

This is a good place to say that stuffing your child with Bamba while waiting to do a painful procedure is never a good idea.

Ketamine is another old drug that is great. The patient is out and will remember nothing. The eyes remain open and the breathing is not affected. However, recovery time can be prolonged.

Tranquilizers such as valium work well and can be given by mouth, by the rectum or by injection. They can affect breathing and do nothing for pain relief. Pain relief must be given.

I love a medication called propofol and a related cousin called etomidate. These medications do the same as tranquilizers, but they give much deeper sedation more reliably. The best part of this is that the drug wears off very fast and pain relief is generally not needed as the sedation is deep. Propofol does affect breathing, and etomidate does not, but etomidate is much more expensive.

Chloral Hydrate is sometimes given by mouth or rectally to sedate kids to do a CT scan. I do not like this side-effect- ridden drug that can not be controlled well.

In the emergency department, fasting helps but usually does not affect our decision to use sedation. I do not expect you to remember all the agents, but take this article with you when you go to the hospital. It is your right to insist on pain relief and not have your child pounced on by large humans or tied down. You should also be present for the procedure and do your best to be supportive and helpful.

Let me also add that these agents are not general anesthesia. The agents used before an operation cause much deeper sedation, and need a respirator to control breathing. They must be given on an empty stomach. Write me in care of the Yated.

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