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  • Print publication year: 2010
  • Online publication date: July 2010

Chapter 21 - Post-operative critical care

from Section II: - Systemic disorders and management

Summary

There are many clinical scoring systems to provide an assessment of levels of sedation, and commonly used ones include Ramsay and Bloomsbury scales. The other assessment tools are electroencephalograms, bispectral index, and auditory evoked potentials. It takes four half-lives of a drug given by intravenous infusion to achieve steady state. It is therefore necessary to start with a loading dose to minimize delays to achieve adequate sedation. The side effects of sedatives, ideal properties of sedatives, and commonly used sedatives are discussed in this chapter. The chapter reviews intravenous anaesthetic agents, volatile anaesthetic agents, benzodiazepines, opioids, alpha-2 receptor agonists, neuroleptic agents, neuromuscular blockade, and use of protocols and sedation breaks. The recent Awakening and Breathing Control (ABC) trial suggested that a 'wake up and breathe' protocol that pairs daily spontaneous awakening trials with daily spontaneous breathing trials results in better outcomes for mechanically ventilated patients in intensive care.

Further reading

GandhiGY, MuradMH, FlynnDLet al. (2008) Effect of perioperative insulin infusion on surgical morbidity and mortality: systematic review and meta-analysis of randomized trials. Mayo Clin. Proc. 83(4): 418–30.
HonrubiaT, García LópezFJ, FrancoNet al. (2005) Noninvasive vs. conventional mechanical ventilation in acute respiratory failure: a multicenter, randomized controlled trial. Chest 128: 3916–24.
KeenanS, SinuffT, CookDet al. (2004) Does noninvasive positive-pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit. Care Med. 32: 2516–23.
LawrenceVA, CornellJE, SmetanaGW (2006) Strategies to reduce post-operative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann. Intern. Med. 144(8): 596–608.
POISE Study Group (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371: 1839–47.
SpencerSL, WuCL 2007 Effect of post-operative analgesia on major post-operative complications: a systematic update of the evidence. Anesth. Analg. 104: 689–702.
SquadroneV, CohaM, CeruttiEet al. (2005) Continuous positive airway pressure for treatment of post-operative hypoxemia: a randomized controlled trial. J. Am. Med. Ass. 293: 589–95.