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Modern Sedation and Analgesia Strategies in Neurocritical Care

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Abstract

Purpose of Review

Patients with acute neurologic injury require a specialized approach to critical care, particularly with regard to sedation and analgesia. This article reviews the most recent advances in methodology, pharmacology, and best practices of sedation and analgesia for the neurocritical care population.

Recent Findings

In addition to established agents such as propofol and midazolam, dexmedetomidine and ketamine are two sedative agents that play an increasingly central role, as they have a favorable side effect profile on cerebral hemodynamics and rapid offset can facilitate repeated neurologic exams. Recent evidence suggests that dexmedetomidine is also an effective component when managing delirium. Combined analgo-sedation with low doses of short-acting opiates is a preferred sedation strategy to facilitate neurologic exams as well as patient-ventilator synchrony.

Summary

Optimal care for patients in the neurocritical care population requires an adaptation of general ICU strategies that incorporates understanding of neurophysiology and the need for close neuromonitoring. Recent data continues to improve care tailored to this population.

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Authors and Affiliations

  1. Department of Neurology-Westchester Medical Center, New York Medical College, Valhalla, NY, USA

    Andrew Bauerschmidt, Syed Ali, Jessica Dorilio, Jon Rosenberg & Fawaz Al-Mufti

  2. Department of Neurosurgery-Westchester Medical Center, New York Medical College, Valhalla, NY, USA

    Andrew Bauerschmidt, Jon Rosenberg & Fawaz Al-Mufti

  3. Department of Pulmonary, Critical Care, and Sleep Medicine-Westchester Medical Center, Valhalla, NY, USA

    Tarik Al-Bermani & Brittany Bass

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  1. Andrew Bauerschmidt
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Correspondence to Andrew Bauerschmidt.

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Bauerschmidt, A., Al-Bermani, T., Ali, S. et al. Modern Sedation and Analgesia Strategies in Neurocritical Care. Curr Neurol Neurosci Rep 23, 149–158 (2023). https://doi.org/10.1007/s11910-023-01261-7

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