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analgosedation on ICU

Andrew C Faust, Pearl Rajan, Lyndsay A Sheperd, Carlos A Alvarez, Phyllis McCorstin, Rebecca L Doebele
BACKGROUND: Recent attention to adverse effects of intensive care unit (ICU) sedation has led to the use of strategies that target a "lighter" depth of sedation. Among these strategies are "analgosedation" protocols, which prioritize pain management and preferentially use IV opioids before administration of continuously infused sedatives such as propofol or midazolam. We hypothesized that using an analgosedation protocol would result in a shorter duration of mechanical ventilation than a protocol with greater emphasis on IV sedatives METHODS: : We conducted a retrospective study comparing the duration of mechanical ventilation before and after implementation of an analgosedation protocol in a 24-bed medical ICU...
October 2016: Anesthesia and Analgesia
Yasuhiro Kuroda
This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition...
2016: Journal of Intensive Care
N S Nosseir, G Michels, P Binder, M H J Wiesen, C Müller
A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method has been developed and validated for the determination and quantification of four predominantly used analgosedatives in the intensive care unit: ketamine, lorazepam, midazolam and sufentanil in human serum. The extraction procedure consisted of protein precipitation of serum samples with acetonitrile and subsequent centrifugation. D5-fentanyl and D4-midazolam served as internal standards (ISTD). Separation of analytes was performed with a Hypersil C18 column and a mobile phase with acetonitrile and 0...
October 12, 2014: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
D Volz, A Vogt, M Schütz, H-B Hopf
BACKGROUND: Delirium is defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) as a potentially reversible disturbance of consciousness and a change of cognition caused by a medical condition, drug intoxication, or medication side effect. Delirium affects up to 80 % of intensive care unit (ICU) patients and is associated with increased morbidity and mortality. One risk factor for development of delirium in ventilated intensive care unit patients is sedation...
June 2014: Der Anaesthesist
Kristen M Tedders, Kelly N McNorton, Stephanie B Edwin
OBJECTIVES: To compare the efficacy and safety of analgosedation with fentanyl versus traditional sedation with propofol in critically ill patients receiving mechanical ventilation. METHODS: Retrospective, observational study evaluating adult critically ill patients on mechanical ventilation at a community teaching hospital who received continuous infusion fentanyl (n=50) or propofol (n=50) from September 2011-March 2013. RESULTS: Median duration of mechanical ventilation was similar between patients receiving propofol and fentanyl infusions (46...
June 2014: Pharmacotherapy
M C Mondardini, B Vasile, A Amigoni, S Baroncini, A Conio, A Mantovani, E Corolli, F Ferrero, F Stoppa, G Vigna, E Lampugnani, M L'Erario
Effective and adequate therapy to control pain and stress are essential in managing children in Pediatric Intensive Care Unit (PICU) undergoing painful invasive procedures, this should be, but is not yet, one of our main aims. Aware that this difficult mission must be pursued in a systematic, multimodal and multitasking way, the Studying Group on Analgosedation in PICU from the Italian Society of Neonatal and Paediatric Anesthesia and Intensive Care (SARNePI) is providing its recommendations.
September 2014: Minerva Anestesiologica
S N Piper, R Beschmann, A Mengistu, A Kalenka, W H Maleck, J Boldt, K D Röhm
BACKGROUND: S(+)-ketamine is an analgesic and sedative drug with dissociative attributes. When it is used without sedatives, nightmares have been described. The aim of this study was to assess the effects of postoperative analgosedation with propofol and S(+)-ketamine when compared to standard propofol analgosedation in terms of recovery, dreaming, hemodynamics, and patient satisfaction. METHODS: Forty-eight patients were sedated with propofol (1-3 mg/kg/h) after coronary artery bypass grafting and allocated randomly on admission to the intensive care unit to receive either S(+)ketamine (2 mg mg/kg/h; group A) or 0...
June 2009: Minerva Anestesiologica
Swen N Piper, Ralf B Beschmann, Andinet Mengistu, Wolfgang H Maleck, Joachim Boldt, Kerstin D Röhm
BACKGROUND: Along with postoperative nausea and vomiting (PONV), postanesthetic shivering (PAS) is one of the leading causes of distress postoperatively. Previous studies report on a decrease in incidence of PAS due to ketamine administration; however, the S(+) isomer of ketamine has not been evaluated before. Additionally the administration of ketamine minimizes the use of opioids, one of the most important risk factor of PONV. The aim of the present study was to evaluate the efficacy of S(+)-ketamine in the prophylaxis of both PAS and PONV in patients undergoing cardiac surgery...
December 2008: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Diederik Gommers, Jan Bakker
Critically ill patients are often treated with continuous intravenous infusions of sedative drugs. However, this is associated with high risk for over-sedation, which can result in prolonged stay in the intensive care unit. Recently introduced protocols (daily interruption and analgosedation) have proven to reduce the length of intensive care unit stay. To introduce these protocols, new agents or new regimens with the well established agents may be required. In this article we briefly discuss these new regimens and new agents, focusing on the short-acting substances...
2008: Critical Care: the Official Journal of the Critical Care Forum
J Enders, C Gebauer, F Pulzer, E Robel-Tillig, M Knüpfer
BACKGROUND: CPAP is widely used in preterm infants on NICUs but it poses a stressful stimulus to the patient, sometimes requiring the use of analgosedative drugs. AIM: The aim of this study is to evaluate the risks and benefits associated with the use of low-dose morphine in preterm infants with CPAP, especially apnea. METHODS: Sixty-four CPAP-treated preterm infants, who received a low single dose of morphine (recommended 0.01 mg/kg), were included in this prospective study...
July 2008: Acta Paediatrica
Torsten Paul, Björn Lemmer
Melatonin, cortisol, heart rate, blood pressure, spontaneous motor activity, and body temperature follow stable circadian rhythms in healthy individuals. These circadian rhythms may be influenced or impaired by the loss of external zeitgebers during analgosedation, critical illness, continuous therapeutic intervention in the intensive care unit (ICU), and cerebral injury. This prospective, observational, clinical study examined 24 critically ill analgo-sedated patients, 13 patients following surgery, trauma, or acute respiratory distress (ICU), and 11 patients with acute severe brain injury following trauma or cerebral hemorrhage (CCI)...
2007: Chronobiology International
I Rundshagen, K Schnabel, C Wegner, SchulteJ am Esch
OBJECTIVE: To define the incidence of recall and dreams during analgosedation in critically ill patients. DESIGN: Prospective clinical study. SETTING: Anaesthesiological intensive care unit (ICU) in a university hospital. PATIENTS AND PARTICIPANTS: Two hundred and eighty-nine critically ill patients, who either arrived intubated and sedated at the ICU or required intubation, mechanical ventilation, and sedation during their ICU stay...
January 2002: Intensive Care Medicine
S Petros, L Engelmann
OBJECTIVE: To test a short indirect calorimetry protocol with five stable 1-min readings (5-min steady state) against the commonly used protocol of 30 1-min readings (30-min steady state) in critically ill patients with various modes of ventilation. DESIGN: A prospective clinical study. SETTING: A medical ICU of a university hospital. SUBJECTS: Forty-six mechanically ventilated patients (group A and B), and 16 spontaneously breathing patients (group C)...
July 2001: Intensive Care Medicine
V P Hoffmann, M Imhoff
Any patient admitted to an intensive care unit requires individual analgetic and sedative treatment, depending on type and severity of the disease with its associated physical and psychic problems. There is a wide range of possible medicaments and combinations of these from among which the authors investigated combinations of the short-action opiates fentanyl and alfentanyl and midazolam, a benzodiazepine, short-action as well. These were tested for their effects on several circulatory parameters, intracranial pressure, wake-up behaviour, and selected hormonal parameters of mechanically ventilated patients...
1988: Zentralblatt Für Chirurgie
K A Lehmann
The goal of analgesia and sedation in intensive care units is most often achieved using numerous drug combinations, mostly justified by physicians' and nurses' habits instead of rational pharmacological criteria for the choice of drugs and dosages. The present paper aims at defining the analgesic situation of ventilated intensive care patients and concludes from analogy with other, better understood states of pain that the importance of analgesic drugs is frequently overrated. To achieve effective analgesia and sedation in individual patients, the dosage must be titrated to individual needs...
1991: Klinische Wochenschrift
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