Use of Analgesics and Sedatives in Critical Care

  • Rodger E. Barnette
  • Gerard J. Criner

Abstract

Most patients admitted to an intensive care unit (ICU) struggle with anxiety, fear, apprehension, and loss of control. In addition, critically ill patients often undergo a variety of diagnostic and therapeutic interventions, most of which are associated with physical discomfort or pain. In some patients, there will be an indication for the use of neuromuscular blocking agents; patients receiving these agents will be completely unable to communicate, so the need for adequate and consistent sedation, anxiolysis, and analgesia will be even more important. Fortunately, a variety of agents and techniques are available to alleviate both pain and anxiety. To safely utilize these methods of pain control and anxiolysis, however, the clinician must possess current knowledge regarding the advantages, disadvantages, and potential side effects of each of these agents.

Keywords

Catheter Lipase Diazepam Ketamine Hypoglycemia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Suggested Reading

  1. Cammarano WB, Pittet JF, Weitz S, et al. Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Crit Care Med 1998; 26: 676684.Google Scholar
  2. Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.PubMedCrossRefGoogle Scholar
  3. Devlin JW, Boleski G, Mlynarek M, et al. Motor activity assessment scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med 1999; 27: 1271–1275.PubMedCrossRefGoogle Scholar
  4. Marinella MA. Propofol for sedation in the intensive care unit: essentials for the clinician. Respir Med 1997; 91: 505–510.PubMedCrossRefGoogle Scholar
  5. Morgan D, Cook CD, Smith MA, Picker MJ. An examination of the interactions between the antinociceptive effects of morphine and various opioids: the role of intrinsic efficacy and stimulus intensity. Anesth Analg 1999; 88: 407–413.PubMedGoogle Scholar
  6. Pasternak GW. Pharmacological mechanisms of opioid analgesics. Clin Neuropharmacol 1993; 16: 1–18.PubMedCrossRefGoogle Scholar
  7. Shapiro B, Warren J, Egol A, et al. Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Crit Care Med 1995; 23: 1596–1600.PubMedCrossRefGoogle Scholar
  8. Wagner BKJ, O’Hara DA. Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients. Clin Pharmacokinet 1997; 33: 426–453.PubMedCrossRefGoogle Scholar
  9. Wagner BKJ, Zavotsky KE, Sweeney JB, Palmeri BA, Hammond JS. Patient recall of therapeutic paralysis in a surgical critical care unit. Pharmacotherapy 1998; 18: 358–363.PubMedGoogle Scholar
  10. Wang JJ, Tai S, Lee ST, Liu YC. A comparison among nalbuphine, meperidine and placebo for treating postanesthetic shivering. Anesth Analg 1999; 88: 686–689.PubMedGoogle Scholar
  11. Watling SM, Dasta JF, Seidl EC. Sedatives, analgesics, and paralytics in the ICU. Ann Pharmacother 1997; 31: 148–153.PubMedGoogle Scholar
  12. Zorumski CF, Isenberg KE: Insights into the structure and function of GABA-benzodiazepine receptors: ion channels and psychiatry. Am J Psychiatry 1991; 148: 162–173.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Rodger E. Barnette
  • Gerard J. Criner

There are no affiliations available

Personalised recommendations