Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic principles
- 1 Cardiac function, monitoring, oxygen transport
- 2 Shock
- 3 Oxygen therapy
- 4 Central venous access
- 5 Fluid therapy in ICU
- 6 Anaemia and blood transfusion
- 7 Nutrition
- 8 Non-invasive mechanical ventilation
- 9 Principles of IPPV
- 10 Modes of ventilation and ventilatory strategies
- 11 Weaning and tracheostomy
- 12 Vasoactive drugs
- 13 Infection and infection control
- 14 Sedation, analgesia and neuromuscular blockade
- 15 Continuous renal replacement therapy
- 16 Withholding and withdrawing therapy in the ICU
- Part II Specific problems
- Index
14 - Sedation, analgesia and neuromuscular blockade
Published online by Cambridge University Press: 24 August 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic principles
- 1 Cardiac function, monitoring, oxygen transport
- 2 Shock
- 3 Oxygen therapy
- 4 Central venous access
- 5 Fluid therapy in ICU
- 6 Anaemia and blood transfusion
- 7 Nutrition
- 8 Non-invasive mechanical ventilation
- 9 Principles of IPPV
- 10 Modes of ventilation and ventilatory strategies
- 11 Weaning and tracheostomy
- 12 Vasoactive drugs
- 13 Infection and infection control
- 14 Sedation, analgesia and neuromuscular blockade
- 15 Continuous renal replacement therapy
- 16 Withholding and withdrawing therapy in the ICU
- Part II Specific problems
- Index
Summary
Introduction
The two terms, sedation and analgesia, as used in the intensive care unit (ICU) setting, may be defined as follows:
Sedation: for hypnosis and anxiolysis.
Analgesia: for pain relief and suppression of respiratory drive.
In the 1980s ventilated patients were often deeply sedated and routinely paralysed with muscle relaxants.
In recent years many critically ill patients have come to be managed at much lighter levels of sedation, often without the coincident use of muscle relaxants [1] as a result of the following developments:
Novel modes of mechanical ventilation which more readily complement and synchronise with the patient's own intrinsic respiratory pattern.
A steady trend towards early percutaneous tracheostomy.
Wider appreciation of the hazards and negative effects of excessive sedation and analgesia and the routine use of muscle relaxants.
Sleep, factual memory and amnesia
Patients in the ICU rarely have a normal sleep cycle [2]. They experience reduced rapid eye movement and slow wave sleep, both of which are important for the integration of factual memories [2, 3].
Complete amnesia results in fragmentation and distortion of patient's memory of their ICU stay in turn leading to delusional dreams with impairment of the experience and recognition of external reality [4]. This sequence of events has been postulated as a cause of anxiety, depression and later chronic stress disorders in some ICU patients [5].
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- Chapter
- Information
- Handbook of ICU Therapy , pp. 170 - 183Publisher: Cambridge University PressPrint publication year: 2006