Skip to main content
SpringerLink
Log in

Sedierung und Analgesie

  • Chapter
NeuroIntensiv

  • 1446 Accesses

Auszug

Das Bild eines analgosedierten Patienten auf einer Intensivstation hat sich in den letzten beiden Jahrzehnten grundlegend verändert. Dazu haben neue, besser geeignete Medikamente für die Analgosedierung beigetragen, aber auch eine deutlich differenziertere Beatmungstherapie von kritisch Kranken. Während noch vor wenigen Jahren Patienten auf Intensivstationen im wesentlichen tief sediert und nicht kooperationsfähig waren, setzt sich zunehmend die Erkenntnis durch, dass der Bewusstseinsgrad eines Patienten nur so weit eingeschränkt sein sollte, wie es im Rahmen des zugrunde liegenden Krankheitsbildes und der entsprechenden Therapie erforderlich ist. Eine regelmäßige Überprüfung der Sedierungstiefe, wie z. B. durch eine tägliche Unterbrechung der Sedierung bis zum Wiederauftreten der Wachheit eines Patienten, kann zu einer signifikanten Reduktion der Beatmungsdauer, aber auch der Aufenthaltsdauer auf der Intensivstation führen [1]. Die Analgosedierung von Patienten auf einer Intensivstation ist somit untrennbar mit dem Outcome verbunden.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342: 1471–1477

    Article  PubMed  CAS  Google Scholar 

  2. Elliott MW, Confalonieri M, Nava S (2002) Where to perform noninvasive ventilation? Eur Respir J 19: 1159–1166

    Article  PubMed  CAS  Google Scholar 

  3. Jacobi J, Fraser GL, Coursin DB et al. (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30: 119–141

    Article  PubMed  Google Scholar 

  4. Ely EW, Shintani A, Truman B et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291: 1753–1762

    Article  PubMed  CAS  Google Scholar 

  5. Milbrandt EB, Deppen S, Harrison PL et al. (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32: 955–962

    Article  PubMed  Google Scholar 

  6. Prause A, Wappler F, Scholz J et al. (2000) Respiratory depression under long-term sedation with sufentanil, midazolam and clonidine has no clinical significance. Intensive Care Med 26: 1454–1461

    Article  PubMed  CAS  Google Scholar 

  7. Monk JP, Beresford R, Ward A. (1988) Sufentanil. A review of its pharmacological properties and therapeutic use. Drugs 36: 286–313

    Article  PubMed  CAS  Google Scholar 

  8. Wappler F, Scholz J, Prause A et al. (1998) Level concept of analgesic dosing in intensive care medicine with sufentanil. Anasthesiol Intensivmed Notfallmed Schmerzther 33: 8–26

    PubMed  CAS  Google Scholar 

  9. Burkle H, Dunbar S, Van Aken H (1996) Remifentanil: a novel, shortacting, mu-opioid. Anesth Analg 83: 646–651

    Article  PubMed  CAS  Google Scholar 

  10. Scholz J, Steinfath M. (1996) Is remifentanil an ideal opioid for anesthesiologic management in the 21st century? Anasthesiol Intensivmed Notfallmed Schmerzther 31: 592–607

    PubMed  CAS  Google Scholar 

  11. Wilhelm W, Biedler A, Larsen R (1997) Remifentanil. Early clinical experiences with 3100 patients. Anaesthesist 46: 992–997

    Article  PubMed  CAS  Google Scholar 

  12. Wilhelm W, Dorscheid E, Schlaich N et al. (1999) The use of remifentanil in critically ill patients. Clinical findings and early experience. Anaesthesist 48: 625–629

    Article  PubMed  CAS  Google Scholar 

  13. Hammerlein A, Derendorf H, Lowenthal DT (1998) Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications. Clin Pharmacokinet 35: 49–64

    Article  PubMed  CAS  Google Scholar 

  14. Tonner PH, Kampen J, Scholz J (2003) Pathophysiological changes in the elderly. Best Pract Res Clin Anaesthesiol 17: 163–177

    Article  PubMed  Google Scholar 

  15. Young C, Knudsen N, Hilton A, Reves JG (2000) Sedation in the intensive care unit. Crit Care Med 28: 854–866

    Article  PubMed  CAS  Google Scholar 

  16. Young CC, Prielipp RC (2001) Benzodiazepines in the intensive care unit. Crit Care Clin 17: 843–862

    Article  PubMed  CAS  Google Scholar 

  17. Barr J, Zomorodi K, Bertaccini EJ et al. (2001) A double-blind, randomized comparison of i.v. lorazepam versus midazolam for sedation of ICU patients via a pharmacologic model. Anesthesiology 95: 286–298

    Article  PubMed  CAS  Google Scholar 

  18. Ariano RE, Kassum DA, Aronson KJ (1994) Comparison of sedative recovery time after midazolam versus diazepam administration. Crit Care Med 22: 1492–1496

    Article  PubMed  CAS  Google Scholar 

  19. Bray RJ (1998) Propofol infusion syndrome in children. Paediatr Anaesth 8: 491–499

    Article  PubMed  CAS  Google Scholar 

  20. Parke TJ, Stevens JE, Rice AS et al. (1992) Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 305: 613–616

    PubMed  CAS  Google Scholar 

  21. Arzneimittelkommission der deutschen Ärzteschaft (2004) Schwere unerwünschte Arzneimittelwirkungen nach Propofolinfusionen zur Sedierung. Dtsch Ärztebl 50: A3447

    Google Scholar 

  22. Huang C, Long H, Shi YS et al. (2005) Ketamine enhances the efficacy to and delays the development of tolerance to electroacupuncture-induced antinociception in rats. Neurosci Lett 375: 138–142

    Article  PubMed  CAS  Google Scholar 

  23. Subramaniam B, Subramaniam K, Pawar DK, Sennaraj B (2001). Preoperative epidural ketamine in combination with morphine does not have a clinically relevant intra-and postoperative opioid-sparing effect. Anesth Analg 93: 1321–1326

    Article  PubMed  CAS  Google Scholar 

  24. Dorman T, Clarkson K, Rosenfeld BA et al. (1997) Effects of clonidine on prolonged postoperative sympathetic response. Crit Care Med 25: 1147–1152

    Article  PubMed  CAS  Google Scholar 

  25. Spies CD, Dubisz N, Neumann T et al. (1996) Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial. Crit Care Med 24: 414–422

    Article  PubMed  CAS  Google Scholar 

  26. Vayer P, Mandel P, Maitre M (1987) Gamma-hydroxybutyrate, a possible neurotransmitter. Life Sci 41: 1547–1557

    Article  PubMed  CAS  Google Scholar 

  27. Feigenbaum JJ, Howard SG (1996) Gamma hydroxybutyrate is not a GABA agonist. Prog Neurobiol 50: 1–7

    Article  PubMed  CAS  Google Scholar 

  28. Okun MS, Boothby LA, Bartfield RB, Doering PL (2001) GHB: an important pharmacologic and clinical update. J Pharm Pharm Sci 4: 167–175

    PubMed  CAS  Google Scholar 

  29. Martin J, Bäsell K, Bürkle H et al. (2005) Analgesie und Sedierung in der Intensivmedizin — Kurzversion. S2-Leitlinien der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin. Anästh Intensivmed 46: S1–20

    Google Scholar 

  30. Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. Br Med J 2: 656–659

    Article  PubMed  CAS  Google Scholar 

  31. Sessler CN, Gosnell MS, Grap MJ et al. (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166: 1338–1344

    Article  PubMed  Google Scholar 

  32. Ely EW, Truman B, Shintani A et al. (2003) Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 289: 2983–2991

    Article  PubMed  Google Scholar 

  33. Johansen JW, Sebel PS (2000) Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology 93: 1336–1344

    Article  PubMed  CAS  Google Scholar 

  34. Bruhn J, Bouillon TW, Radulescu L et al. (2003) Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of «anesthetic depth» during coadministration of propofol and remifentanil. Anesthesiology 98: 621–627

    Article  PubMed  CAS  Google Scholar 

  35. Rampil IJ (1998) A primer for EEG signal processing in anesthesia. Anesthesiology 89: 980–1002

    Article  PubMed  CAS  Google Scholar 

  36. Gan TJ, Glass PS, Windsor A et al. (1997) Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology 87: 808–815

    Article  PubMed  CAS  Google Scholar 

  37. De Deyne C, Struys M, Decruyenaere J et al. (1998) Use of continuous bispectral EEG monitoring to assess depth of sedation in ICU patients. Intensive Care Med 24: 1294–1298

    Article  PubMed  Google Scholar 

  38. Simmons LE, Riker RR, Prato BS, Fraser GL (1999) Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale. Crit Care Med 27: 1499–1504

    Article  PubMed  CAS  Google Scholar 

  39. Riker RR, Fraser GL, Simmons LE, Wilkins ML (2001) Validating the Sedation-Agitation Scale with the Bispectral Index and Visual Analog Scale in adult ICU patients after cardiac surgery. Intensive Care Med 27: 853–858

    Article  PubMed  CAS  Google Scholar 

  40. Riess ML, Graefe UA, Goeters C et al. (2002) Sedation assessment in critically ill patients with bispectral index. Eur J Anaesthesiol 19: 18–22

    Article  PubMed  CAS  Google Scholar 

  41. Bruhn J, Bouillon TW, Shafer SL (2000) Electromyographic activity falsely elevates the bispectral index. Anesthesiology 92: 1485–1487

    Article  PubMed  CAS  Google Scholar 

  42. Nasraway SS, Wu EC, Kelleher RM et al. (2002) How reliable is the Bispectral Index in critically ill patients? A prospective, comparative, single-blinded observer study. Crit Care Med 30: 1483–1487

    Article  Google Scholar 

  43. Tonner PH, Weiler N, Paris A, Scholz J (2003) Sedation and analgesia in the intensive care unit. Curr Opin Anaesthesiol 16: 113–121

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, operative und allgemeine Intensivmedizin, Notfallmedizin Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen

    Prof. Dr. P. H. Tonner

  2. Klinik für Anästhesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München

    Dr. E. Schaffrath

Authors
  1. Prof. Dr. P. H. Tonner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dr. E. Schaffrath
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Neurologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen

    Stefan Schwab  & Peter Schellinger  & 

  2. Klinik für Anästhesiologie, Klinikum der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz

    Christian Werner

  3. Neurochirurgische Klinik, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg

    Andreas Unterberg  & Werner Hacke  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Medizin Verlag Heidelberg

About this chapter

Cite this chapter

Tonner, P.H., Schaffrath, E. (2008). Sedierung und Analgesie. In: Schwab, S., Schellinger, P., Werner, C., Unterberg, A., Hacke, W. (eds) NeuroIntensiv. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68317-9_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-68317-9_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-23051-9

  • Online ISBN: 978-3-540-68317-9

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation