Description
Sedation and analgesia are commonly used in the critical care setting to reduce patient discomfort and promote recovery. The goals of sedation and analgesia in critical care include reducing pain and anxiety, promoting patient comfort, and facilitating mechanical ventilation. It can help to reduce the duration of mechanical ventilation and ICU stay. There are several classes of drugs used for sedation and analgesia in critical care, including benzodiazepines, opioids, propofol, and dexmedetomidine. Opioids are effective for pain control in critical care, but they can cause respiratory depression, constipation, and nausea. The use of sedation and analgesia in critical care should be based on the principles of "start low and go slow," meaning that the lowest effective dose should be used and titrated upwards as necessary. Patient-controlled analgesia (PCA) is an effective way to provide pain relief while minimizing the risk of overdose and adverse effects.
Résumé
- Sedation and analgesia are crucial in hospital settings to address patient anxiety and pain stemming from their condition and fear of outcomes. Uncontrolled anxiety and pain can trigger systemic inflammatory responses, prolonging hospital stays and increasing treatment costs.
- Analgesic sedation should be used to address a holistic approach, taking into account the physiological responses, duration of meds, and the individual characteristics of the receptors involved in pain. Pharmacological and non-pharmacological interventions are useful in management.
- The pain receptors A Delta, C Fibers, mu, and Gaba receptors are the main targets of multi-modal analgesia. NSAIDs target A Delta C Fibers, Opioids target new receptors, and benzodiazepines target Gaba receptors.
- Treatment for pain is tiered and starts by determining the severity of the pain and the right drug. Visual Analogue Score or pain score is useful in defining the pain parameters.
- Opioids like morphine and fentanyl are used to control pain via different administrations. Some of the side effects of opioids are the depression of respiration, hypotension, or constipation.
- NSAIDs used as cyclooxygenase inhibitors can cause GI bleeding and renal problems. Paracetamol is also another useful agent that should be used wisely due to its toxicity.
- Preemptive analgesia is preferred over treating already established pain. PCA can be adopted. Intramuscular administration should be avoided due to the development of gangrenous changes. Epidural drug routes and transdermal patches are also other suitable routes.
- Benzodiazepines act on Gaba receptors to relieve anxiety and promote amnesia. Midazolam is the shortest acting sedative, and lorazepam has a long half-life and can cause acidosis. Diazepam has a long half life and can cause pain in the injection site.
- Propofol is a rapid-acting anesthetic with a short duration, although it can cause acidosis. Ketamine can be used as a Bronco dilator but causes hallucinations. Herber doll is used for hallucinations that may have C prolongation.
- Visual analogue scores, Ramsay scores, transition scores, and other forms can reliably monitor assessment for sedation and analgesia. Daily Interruption of a is useful to reduce doses, mortality, and morbidity.
Exemple de certificat
À propos des intervenants
Dr Aklesh Tandekar
Spécialiste en soins intensifs, MD, EDIC, IDCCM, FIMSA, DA, FCPS, FISCCM, hôpitaux Apollo, Mumbai.
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