Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 44 Sedation and analgesia
- 45 Neurological complications
- 46 Psychiatric illness during and after discharge from critical care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
44 - Sedation and analgesia
from 3.8 - NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 44 Sedation and analgesia
- 45 Neurological complications
- 46 Psychiatric illness during and after discharge from critical care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
To provide adequate sedation and analgesia is integral to the care and management of the patient in critical care.
Indications
The postoperative patient
In contrast to most other types of surgery, patients after cardiac surgery are usually sedated and ventilated in the immediate postoperative period, until normothermia and haemodynamic stability are achieved and lack of bleeding is confirmed.
NORMOTHERMIA
Sedation allows a reduction of oxygen consumption during rewarming; it inhibits shivering. Shivering is associated with a three- to four-fold increase in O2 consumption and leads to an increase in CO2 production with respiratory acidosis. Intraoperative hypothermia should be avoided where possible and active warming employed. Increasing sedation or adding clonidine may be beneficial if shivering persists.
HAEMODYNAMIC STABILITY
Early postoperative haemodynamic instability can have many causes, and might necessitate reexploration or further investigation. Deep levels of sedation were advocated in the past to reduce the stress response of cardiac surgery and the incidence of myocardial ischemia, but this is no longer thought to be beneficial. Moreover, heavy sedation has itself been associated with increased myocardial ischemia.
The non-postoperative patient
The most common reason for sedation in critical care is to permit mechanical ventilation and tolerance of the artificial airway (endotracheal tube). Low levels of sedation should be used and patients should ideally be easy to rouse and remain calm and cooperative.
- Type
- Chapter
- Information
- Core Topics in Cardiothoracic Critical Care , pp. 345 - 351Publisher: Cambridge University PressPrint publication year: 2008