GELOFUSINE

Indications

• Low blood volume
• Hypovolemic shock
• Burns
• Cardiopulmonary bypass

Dosage

Children: Initially 10-20 mL per kilogram. Adjust according to the patient's condition and response, using 3.5-4% solution. Use under specialist supervision to mitigate the risk of fluid overload.

Adults: Dose according to requirements, typically administered intravenously. Consult product literature for specific dosing guidance.

Mechanism of action

Gelatin acts as a plasma expander by increasing the oncotic pressure in the vascular compartment, which helps to retain fluid within the bloodstream and restore circulating blood volume. This mechanism aids in maintaining blood pressure and improving tissue perfusion.

Pharmacodynamics

Gelatin solutions increase blood volume and improve hemodynamic stability in patients experiencing hypovolemic conditions. By drawing water into the vascular space, they help to counteract the effects of low blood volume, such as hypotension and compromised organ perfusion.

Pharmacokinetics

Gelatin is administered intravenously, and its effects can be observed relatively quickly. The half-life and the metabolic clearance depend on the formulation and concentration of the solution. Gelatin is gradually metabolized by macrophages and eliminated by the renal system. Close monitoring of fluid balance is essential, particularly in patients with cardiac or renal impairment.

Contra-indications

• Severe liver disease
• History of circulatory disease
• Severe cardiac disease

Adverse effects

• Fever
• Flushing
• Nausea
• Urticaria
• Rare or very rare shock

Interactions

• Calcium salts

Precautions

• Monitor cardiovascular and respiratory function
• Correct dehydration when administering
• Administer slowly to avoid rapid rise in blood pressure and cardiac failure
• Increased capillary permeability

Pregnancy

Consult product literature for specific guidance regarding use in pregnancy.

Breast-feeding

Consult product literature for specific guidance regarding use in breastfeeding.

Storage

Store at controlled room temperature, protect from light. Refer to product-specific storage instructions.

Formulations

• 5% solution for infusion
• 20% solution for infusion
• Concentrated solution (15-25% protein)
• Isotonic solution (3.5-5% protein)

Indications

• Facilitation of tracheal intubation
• Muscle relaxation during surgery
• Treatment of convulsions in certain conditions

Dosage

Children: For paediatric dosing, consult the BNF for Children, as specific dosing can vary based on age, weight, and clinical circumstance.

Adults: Dosing for succinyl should be guided by clinical protocols and the specific context of use. Generally, initial doses range from 0.3 to 1.0 mg/kg intravenously, followed by maintenance doses as required.

Mechanism of action

Succinylcholine, the active form of succinyl, acts as a depolarizing neuromuscular blocker. It binds to nicotinic acetylcholine receptors at the motor end plate, leading to depolarization and subsequent muscle contraction. However, Succinylcholine is not broken down by acetylcholinesterase, which results in prolonged depolarization and paralysis as the receptors cannot respond to further acetylcholine release.

Pharmacodynamics

The onset of action for succinyl is rapid, typically within 30 seconds, with a duration of effect lasting about 5 to 10 minutes. The drug induces muscle relaxation, which is essential for intubation and surgical procedures. Its effects can be reversed by providing support for ventilation until muscle function returns.

Pharmacokinetics

Succinyl is administered intravenously and is rapidly distributed throughout the body. It is metabolized in the plasma by the enzyme pseudocholinesterase, which leads to its quick inactivation. The half-life of succinyl is very short due to this rapid metabolism, and the drug is excreted primarily through urine and bile. Variability in pseudocholinesterase activity among patients can affect the duration of neuromuscular blockade.

Contra-indications

• Known hypersensitivity to succinylcholine or any of its components
• Personal or family history of malignant hyperthermia
• Myasthenia gravis
• Severe burns or trauma
• Neuromuscular diseases

Adverse effects

• Muscle fasciculations
• Postoperative muscle pain
• Prolonged neuromuscular blockade
• Hyperkalemia
• Cardiac arrest
• Malignant hyperthermia
• Allergic reactions

Interactions

• Aminoglycoside antibiotics may potentiate neuromuscular blockade
• Calcium channel blockers may enhance the effects of succinylcholine
• Certain anesthetics may increase the risk of malignant hyperthermia
• Cholinesterase inhibitors may prolong the effects of succinylcholine

Precautions

• Use with caution in patients with cardiovascular disease
• Monitor patients with a history of respiratory disorders
• Careful in patients with electrolyte imbalances, particularly hyperkalemia
• Use cautiously in patients with severe liver or kidney dysfunction

Pregnancy

Limited data on succinylcholine use in pregnancy. Use only if the benefits justify the risks.

Breast-feeding

Unknown if succinylcholine is excreted in human milk. Caution is advised.

Storage

Store at room temperature, away from light. Protect from freezing.

Formulations

• Injection: 20 mg/mL
• Powder for solution: 50 mg vials