The opening and maintaining anesthesia. As the induction means in an inhalation anesthetic or sedative component when combined anesthesia, including when total intravenous anesthesia (intravenous bolus and infusion) stanoplex side effects.
Ataralgezii in combination with ketamine in children (intramuscularly).
Long-term sedation in the intensive care unit (intravenous bolus or infusion ).
Hypersensitivity to benzodiazepines winstrol steroid or to any component of the formulation.
Pregnancy and breast-feeding
Data to assess the safety in pregnancy is not enough.
Benzodiazepines should not be used during pregnancy, unless they have a safer alternative. Appointment of the drug in the last trimester of pregnancy or at high doses during the first stage of labor leads to heart rhythm abnormalities in the fetus, hypotension, a violation of sucking, hypothermia and moderate respiratory depression in the newborn. Furthermore, in children whose mothers were in the late stages of pregnancy is long received benzodiazepines, can form a physical relationship with a certain risk of abstinence syndrome in the postnatal period.
Since passes into breast milk, should not be used in nursing mothers.
-. A strong sedative that requires slow administration and the individual adjustment of the dosage
The dose should be titrated to achieve the desired sedation, which corresponds to the clinical need, physical condition and age of the patient, as well as medical treatment received by them.
In patients older than 60 years, debilitated or chronic patients the dose should be chosen carefully, taking into account the specific factors inherent in each patient. Intravenous conscious sedation dose selected individually; the drug should not be administered quickly or stream. The onset of sedation varies individually, depending on the patient and dosing regimen (infusion rate, dose value). Dose picked individually, if necessary. The effect is achieved after about 2 minutes after the administration, the maximum – average after 2.4 minutes. Adults be slowly administered intravenously at a rate of about 1 mg in 30 seconds. For adults under the age of 60 years starting dose is 2.5 mg for 5-10 minutes prior to the procedure. Subsequent doses are administered at 1 mg, if necessary. Mean total doses ranging from 3.5 to 7.5 mg. Usually it is enough total dose not exceeding 5 mg. Patients over 60 years, debilitated or chronically ill initial dose is decreased to about 1 mg, and it is administered for 5-10 minutes prior to the procedure. Subsequent doses are administered at 0.5-1 mg if necessary. Since in these patients the maximum effect can be achieved not so fast, the next dose should be titrated very slowly and carefully. Usually it is enough total dose not exceeding 3.5 mg. Children Intramuscular drug is administered at a dose of 0.1-0.15 mg / kg in 5-10 minutes prior to the procedure. Patients are able to express more excitement can be administered up to 0.5 mg / kg body weight. Usually it is enough total dose not exceeding 10 mg. Intravenously administered starting dose for 2-3 minutes, and then, before embarking on the procedure to enter or re-dose need to wait 2-3 minutes for the assessment of sedation. If sedation is necessary to strengthen, continue to carefully titrate the dose to achieve the desired degree of sedation. Infants and children up to 5 years of age can take much higher doses than older children and adolescents. Data for non-intubated children under the age of 6 months is limited.These children of the respiratory tract are especially prone to obstruction and hypoventilation, therefore it is imperative to titrate the dose, increasing its smaller “steps” to achieve clinical effect, as well as carefully monitor patients. The initial dose in children 6 months to 5 years of age is 0.05 – 0.1 mg / kg. To achieve the desired effect may be required total dose of 0.6 mg / kg, but it should not exceed 6 mg.The initial dose in children 6 to 12 years is equal to 0.025 – 0.05 mg / kg total dose – up to 0.4 mg / kg (no more . 10 mg) doses for children from 12 to 16 years -. are the same as for adults AnesthesiaPremedikaiiya premedication shortly before the procedure has a sedative effect (drowsiness the occurrence and removal of emotional stress), as well as preoperative causes amnesia.Premedication is usually produced by injection deep into the muscle for 20-60 minutes before induction of anesthesia. can be used in combination with anticholinergics. Intramuscular administrationAdults: For preoperative sedation and eliminate memory preoperative patient events, not within the high risk group (ASA or II of class 1, up to age 60 years) is introduced 0.07-0.1 mg / kg body weight (about 5 mg). Patients older than 60 years old, loose or chronic: reduce the dose individually. If the patient does not receive the drugs at the same time, the recommended dose of is 0.025 – 0.05 mg / kg, the usual dose – 2-3 mg. Patients over 70 years intramuscular winstrol for sale injection should be performed carefully, under continuous observation for possible too strong sleepiness. Children from age 1 to 15: relatively higher dose (per kg of body weight) than adults. Doses in the range of 0.08-0.2 mg / kg proved to be effective and safe. Induction (adults) If administered for induction of anesthesia before other anesthetic agents, the individual response of patients is very variable. Dose should be titrated to the desired effect in accordance with the age and clinical condition of the patient. If entered before other drugs for intravenous induction of anesthesia, the initial dose of each of these drugs can be significantly reduced, sometimes to 25% of the standard starting dose. The desired level of anesthesia is reached by titration. The induction dose is administered intravenously slowly, fractionally. Every second dose not exceeding 5 mg should be administered for 20-30 seconds, making the interval of 2 minutes between doses. Adult patients younger than 60 years: the dose of 0.15-0.2 mg / kg administered intravenously for 20-30 seconds, then you should wait 2 minutes to evaluate the effect. For surgical elderly patients who do not belong to the high risk (ASA class I and II) recommended initial dose of 0.2 mg / kg. Some debilitated patients or patients with serious underlying medical conditions may be quite smaller doses. Adult patients younger than 60 years who did not receive premedication: the dose may be higher, up to 0.3-0.35 mg / kg body weight. It is administered intravenously for 20-30 seconds, then wait for 2 minutes to assess the effect. If needed to complete induction drug is administered an additional dose of about 25% of the original. As an alternative to complete induction can be used liquid inhalation anesthetics. In refractory cases, the induction dose can reach 0.6 mg / kg, however, recovery of consciousness after such doses may be delayed. Patients older than 60 years who have not received premedication required smaller doses of induction ; the recommended starting dose is 0.3 mg / kg for patients with severe concomitant diseases and weakened sufficient induction dose of 0.2-0.25 mg / kg, sometimes only 0.15 mg / kg. not recommended in children for induction of anesthesia, because the experience of its application is limited. The support narcosis maintenance shutdown desired level of consciousness may be achieved either by further intermittent administration of low doses (0.03-0.1 mg / kg) or by continuous intravenous infusion at a dose of 0.03 – 0.1 mg / kg x hour, usually in combination with analgesics. The doses and intervals between doses depend on the individual patient’s response. Patients over 60 years, debilitated or chronically ill to maintain anesthesia required a smaller dose. Children receiving for the purpose of anesthesia (ataralgezii) ketamine, it is recommended to introduce a dose of 0.15 to 0.20 mg / kg intramuscularly.Sufficiently deep sleep is usually achieved after 2-3 minutes. Intravenous sedation in the intensive care desired sedative effect is reached through a gradual adjustment of the dosage, followed by a continuous infusion or bolus fractional drug, depending on the clinical needs of the patient, the age and simultaneously administered drugs. Adults intravenous loading dose is administered fractional slowly.Each repeated dose 1-2.5 mg administered for 20-30 seconds, observing the 2-minute intervals between administrations. The value of an intravenous loading dose can range 0.03-0.3 mg / kg, the total dose is usually enough not more than 15 mg. Patients with hypovolemia, vasoconstriction, or hypothermia loading dose is reduced or not administered at all. If used simultaneously with strong analgesics, the latter should be given to it, in order to dose can be safely titrated at an altitude of sedation caused by the analgesic. the maintenance dose may be 0.03 -0.2 mg / (kg x h). Patients with hypovolemia, vasoconstriction, or hypothermia, reduced maintenance dose. If the patient’s condition allows, you should regularly evaluate the degree of sedation. Children In order to achieve the desired clinical effect of the drug is administered intravenously at a dose of 0.05-0.2 mg / kg is not less than 2-3 minutes (intravenously administered can not be fast). Thereafter moving on continuous intravenous infusion at a dose of 0.06-0.12 mg / kg (1-2 mg / kg / min). If necessary, to increase or maintain the desired effect, the rate of infusion can be increased or decreased (generally by 25% of the initial or subsequent rate) or introduce additional doses . If infusion begin in patients with impaired hemodynamics usual loading dose must be titrated in small “steps “while monitoring hemodynamics (hypotension). These patients have a tendency to respiratory depression when used , they require careful monitoring of respiratory rate and oxygen saturation. Births (<32 weeks) should be administered as a continuous intravenous winstrol steroid infusion at a starting dose of 0.03 mg / kg x hour (0.5 mcg / kg / min) and newborn (> 32 weeks) – at a dose of 0.06 mg / kg / hour (1 mg / kg / min). An intravenous loading dose is not administered to newborns, instead, in the first few hours were infused a bit faster to achieve therapeutic plasma concentrations. The rate of infusion should be frequently and thoroughly reviewed, especially in the first 24 hours to enter the lowest effective dose and reduce the potential for drug accumulation. Special, instructions for dispensing solution ampoule can be diluted with 0.9% sodium chloride, 5% and 10% glucose solution, 5% fructose solution, Ringer’s solution, Hartmann solution and in the ratio of 15 mg of to 100-1000 ml of infusion solution. These solutions remain physically and chemically stable for 24 hours at room temperature and 3 days at 5 ° C (see. Also “Special Considerations”). It should not be diluted 6% solution Makrodeksa glucose or mixing it with alkaline solutions. In addition that may precipitate which is dissolved by shaking at room temperature.