Analgesia and Sedation in Intensive Care

Abstract

Main stems of analgesia and sedation (analgo-sedation) in critically ill patients are: Established protocols for analgo-sedation. Monitoring pain control and depth of sedation with validated scores. Definition of a goal (score range) for depth of sedation adapted to the patient’s situation. In most situations, a calm but arousable and cooperative patient is favored. Continuous dose adjustments or daily interruption of sedation. No clear preference for specific substances. For sedation propofole and midazolame are widely used, while continuous analgesic therapy is best achieved with fentanyl or sufentanil. Haloperidole is of first choice in the treatment of delirium. Other substances may be used. The expected length of treatment may be a criterion for the choice of drug. Regional and patient-controlled analgesia should be considered. Sedative and analgesic substances should be administered separately and not in a fixed dose. Muscle relaxants are reserved for the peri-interventional period and there are only few indications for repeated doses. Gradual discontinuation of medication after long-term analgo-sedation to reduce the incidence of withdrawal syndromes.