Alcohol as a Pain Killer

Alcohol as a Pain Killer Ne intuearis vinum quando flavescit cum splenduerit in vitro color eius ingreditur blande sed in novissimo mordebit ut coluber et sicut regulus venena diffundet The Proverbs Jerome's Latin Vulgate (405 A.D.) www.myprofile.cos.com/eugenefox History 1668 Stirius reported the intravenous administration of alcohol.  1921 Nakagawa conducted experiments with laboratory animals to study IV alcohol combined with chloroform or diethyl ether for induction of anesthesia.  1929 Marin presented first comprehensive study use IV alcohol as a general anestetic.  1944 Variouse clinical reports concerned with the use of IV alcohol.  www.myprofile.cos.com/eugenefox Chemistry & Physical Properties Colorless  Volatil  Hydroscopic  Flamable  Fluid  Obtained by the distilation of saccharine liquids  Freely mix with water and chloroform  Boils at 780C  www.myprofile.cos.com/eugenefox Pharmacokinetics       When ingested it’s rapidly absorbed from the GI tract. Vaporaised absorbed throug the lungs and also from subcutaneouse sites if it’s concentration not excesive. Complete absorbtionrate 2 – 6 hours. Arterio venouse equlibrium established within 5 min. Total body alcohol saturation occurs within 1 hour Ones absorbed it’s distributed throughout all body tissues.Oxidation begins immediately upon absorbtion and continues as long as alcohol remains in the body. www.myprofile.cos.com/eugenefox Pharmacodynamics CNS more markedly affected than any other system  Initial stimulatory action  Primary and continouse CNS depression  Slowing brain activity (similar as hypoxia and hypoglycemia)  Does not increase mental or physical abilities  www.myprofile.cos.com/eugenefox Cardiovascular System  Exerts only montor effects on the circulation  BP and CO remain unchanged  Generalized vasodilatation (especialy affects the cutaneous vessels)  Heat loss www.myprofile.cos.com/eugenefox Clinical Aplications Intravenouse Analgesia alcohol Intravenouse Anesthesia www.myprofile.cos.com/eugenefox Intravenouse Analgesia Was studied in control of somatic pain  0.9% saline infusion or 1.5 ml/kg body weight of absolute alcohol in 10% solution (v/v) in saline per 1 hour.  0.75ml/kg has same effect as the 0.2 mg/kg of morphine with same volume and infusion rate.  www.myprofile.cos.com/eugenefox Intravenouse Anesthesia Original method of Martin 25% alcohol solution at rate of 20 – 40 ml/min,to reach a total dose of 2 to 3 ml/kg within 20 to 25 min. A total dose 2.5 ml/kg induce alcohol coma  Schenlle Infusion of 300ml of 5% alcohol was recommended to produce a blood concentration of 2.5 to 3.0 ml/kg after Thiopental 50 mg itravenously  An 8% w/v alcohol solution diluting 55 ml of absolute alcohol (44mg) in 400 ml of Ringer Lactate solution rapidly infused in 4 to 5 min to total administered dose of 550 ml, if required  www.myprofile.cos.com/eugenefox Side–Effects and Complications Occasional failure to induce sleep with the rapid infusion (small amounts of Barbiturate)  “Hangover”associated with headaches,nausea,vomiting,thirst… (chlordiazepoxide should be given)  Pain during within the rapid infusion of 8%w/v alcohol solution.(usually subsides within 1 min)  Erythrocytic lysis may occur (Hartmann’s solution will prevent this)  www.myprofile.cos.com/eugenefox Dr. Eugene Yevstratov ostlandfox@medscape.com www.myprofile.cos.com/eugenefox