an appropriate pre-op medication

1. is demerol an appropriate pre-op medicaton (or post-op analgesic) for someone who has a malfunctioning kidney?
   Without knowing the functioning of the other kidney - demerol is metabolized to normeperidine which is dependent on the kidneys for excretion.
   (and normeperidine accumulates, seizures can result)
   
   Is demerol appropriate?
2. 

   About GingerSue

   Joined: Oct '04; Posts: 1,975; Likes: 254
   from CA
   Specialty: 20 year(s) of experience

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3. 
   May 27, '07

   Yes because you would know the status of the other kidney. When one kidney has problems a very close eye is kept on the other one. It is even okay with two malfunctioning kidneys if it's a pre-op med because it's a one time dose.
4. 
   May 27, '07

   what about demerol for post-op analgesic?
5. 
   May 27, '07

   Wouldn't be a problem. In the scenario you described, the other kidney is fine.
6. 
   May 27, '07

   Quote from GingerSue

   what about demerol for post-op analgesic?

   Some studies have been done that show demerol is also not very effective as an analgesic. Add that to the concerns about normeperidine build-up, and many places are phasing out using it for analgesia beyone one or two doses.
   
   My patients have also told me that demerol doesn't kill the pain; It gives them a high so that they "don't care about the pain any more". (Maybe another reason why Demerol is so much in demand amongst the addicted/ drug dependent population....)
   
   IMO, if someone's allergic to other analgesics, I'll use demerol if I have to. But I'd rather give them something safer and that works!
   
   In the PACU in my hospital, they use demerol for post-op shivering.
7. 
   May 28, '07

   Quote from pebbles

   
   My patients have also told me that demerol doesn't kill the pain; It gives them a high so that they "don't care about the pain any more".

   I've heard the same thing
8. 
   May 28, '07

   Demerol isn't even formulary in my hospital anymore. It's a lousy analgesic. We stopped using it years ago.
9. 
   May 28, '07

   We only use it post-op for rigors. I haven't seen it used as a pre-op med in over a decade. I usually see Versed just as they're wheeling the pt out the doors.
   
   For post-op analgesia? Never.
10. 
    May 28, '07

    I still see Demerol and morphine in PCA pumps for post-op as well as IV push in the ER.
11. 
    May 28, '07

    Quote from TazziRN

    I still see Demerol and morphine in PCA pumps for post-op as well as IV push in the ER.

    Isn't it interesting how practice varies depending on what part of the country you live in. In my hosp. the only units that even have Demerol are mine (pre-op), ICU and PACU. It's not kept in the Pyxis in any other dept.
12. 
    May 28, '07

    I work on a surgery floor and the doctors are great they usually prescribe different analgesics to try like prescribing T3's, demerol and morphine until the patients find one that works for them and then the nurses use the one that works for the patient
    we also make sure to teach the patient to ask for the analgesic that works for them
    Surprisingly the most effective analgesic that I have found is toradol
13. 
    May 29, '07

    One of the byproducts of Demerol is neurotoxic and easily builds up in the body after about 48 hours of Demerol use.
14. 
    May 29, '07

    thanks for the information
    
    when I took pharmacology recently, my textbook says that meperidine use has greatly declined, now it is recommended for short-term use in healthy individuals, and is contraindicated for treatment of cancer pains. And that normeperidine accumulates with chronic use, large doses, or renal failure. (effects of normeperidine are not reversible with opioid antagonist drugs).

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