# Sedation and analgesia in the ICU

Analgesia, Amnesia, and NM blockade

## Sedatives
- Fentanyl analgosedation (monotherapy) - estimated to be sufficient in 50% of ICU patients (source?)

- dexmetodomidine - less delirium

- propfol - fast on/off

- ketamine

## Anelgesia
Analgesia first modality

## Interventions

- ABCDEF bundle


## Neuromuscular Blockade
Ciastricurium: degraded by Hoffman elimination = predictable even in hepatic and renal failure. Thus, preferred. 

#### Monitoring
Train of 4 = measures neuromuscular blockade by summarizing how many receptors are blocked. Gives pulses through a nerve and 2 Hz and sees how many are conducted

* 4 twitches = 75% or less
* 3 twitches = 85% or less
* 2 twitches = 95% or less
* 1 twitch = 99% or less
* 0 twitch = 100% blocked.

BIS monitoring: uses machine learning algorithm to infer from EEG tracing what level of sedation the patient is at. Note: sedatives (e.g. opiates) will interfere with this.

* 100 = normal
* <60 = amnesia
* 0 = coma