50 Sedation And Analgesia In The ICU
50.1 What this covers
- Sedatives
- Anelgesia
- Interventions
50.2 Learning objectives
- Sedatives
- Anelgesia
- Interventions
- Neuromuscular Blockade
- Monitoring
50.3 Bottom line / summary
- Analgesia, Amnesia, and NM blockade
- Analgesia first modality
- Ciastricurium: degraded by Hoffman elimination predictable even in hepatic and renal failure.
- 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
50.4 Approach
- Fentanyl analgosedation (monotherapy) - estimated to be sufficient in 50% of ICU patients (source?)
- dexmetodomidine - less delirium
- propfol - fast on/off
- ketamine
- ABCDEF bundle
50.5 Red flags / when to escalate
- TODO: List red flags that require urgent escalation.
50.6 Common pitfalls
- TODO: Capture common errors or missed steps.
50.7 References
TODO: Add landmark references or guideline citations.
50.8 Source notes
50.8.1 Sedation And Analgesia In The ICU
51 Sedation and analgesia in the ICU
Analgesia, Amnesia, and NM blockade
51.1 Sedatives
Fentanyl analgosedation (monotherapy) - estimated to be sufficient in 50% of ICU patients (source?)
dexmetodomidine - less delirium
propfol - fast on/off
ketamine
51.2 Anelgesia
Analgesia first modality
51.3 Interventions
- ABCDEF bundle
51.4 Neuromuscular Blockade
Ciastricurium: degraded by Hoffman elimination = predictable even in hepatic and renal failure. Thus, preferred.
51.4.0.1 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