Update 1989 pp 577-585 | Cite as

Sedation During Intensive Care: Overview of the Problem

  • J. M. Desmonts
  • A. Fichelle
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 8)

Abstract

Many of the patients admitted to an intensive care unit (ICU) will require some form of sedation. The indications can be broadly grouped:
  1. 1.

    As an adjunct to psychological support and to facilitate sleep;

     
  2. 2.

    As part in management of patients with confusion, delirium, restlessness, while the underlying cause is being treated;

     
  3. 3.

    To provide sedation during procedures;

     
  4. 4.

    To tolerate endotracheal intubation and mechanical ventilation.

     

Keywords

Morphine Biodegradation Diazepam Fentanyl Midazolam 

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References

  1. 1.
    Dobb GJ, Murphy DF (1985) Sedation and analgesia during intensive care. Clin Anaesthesiol 3:1055–1085Google Scholar
  2. 2.
    Farina ML, Levati A, Tognoni G (1981) A multicenter study of ICU drug utilization. Intensive Care Med 7:125–131PubMedCrossRefGoogle Scholar
  3. 3.
    Wilson WM (1981) Intensive care delirium. Arch Intern Med 130:225CrossRefGoogle Scholar
  4. 4.
    Dubin WR, Field HL, Gastfriend OR (1979) Post-cardiotomy delirium: a critical review. J Thorac Cardiovasc Surg 77:586–594PubMedGoogle Scholar
  5. 5.
    Lazarus NR, Hagens JH (1968) Prevention of psychosis following open heart surgery. Am J Psych 124:1190–1195Google Scholar
  6. 6.
    Rouby JJ (1982) La sédation en réanimation: choix et modalités. Réanim Med Urg, Expansion Scient, Paris, pp 173–182Google Scholar
  7. 7.
    Desmonts JM, Mourlon M, Scardin A, Fichelle A (1982) La sédation en réanimation: définition, indications et principaux agents utilisés. Réanim Med Urg, Expansion Scient, Paris, pp 151–158Google Scholar
  8. 8.
    Mandelli M, Tognoni G, Garattini S (1978) Clinical pharmacokinetics of diazepam. Clin Pharmacokinet 3:72–91PubMedCrossRefGoogle Scholar
  9. 9.
    Lloyd-Thomas AR, Booker PU (1986) Infusion of midazolam in paediatric patients after cardiac surgery. Br J Anaesth 58:1109–1115PubMedCrossRefGoogle Scholar
  10. 10.
    Michalk S, Moncorgé C, Fichelle A, et al (1989) Midazolam infusion for basal sedation in intensive care: absence of accumulation. Intensive Care Med (in press)Google Scholar
  11. 11.
    Byatt CM, Lewis LD, Dawling S, Cochrane GM (1984) Accumulation of midazolam after repeated dosage in patients receiving mechanical ventilation in intensive care unit. Br Med J 289:790–799Google Scholar
  12. 12.
    Stanski DR, Mihm FG, Rosenthal MH, Kaiman SM (1980) Pharmacokinetics of high-dose thiopental used in cerebral resuscitation. Anesthesiology 53:169–171PubMedCrossRefGoogle Scholar
  13. 13.
    Carlon GC, Kahn RC, Goldiner-Howland WS, Turnbull A (1983) Long term infusion of sodium thiopental. Crit Care Med 6:311–316CrossRefGoogle Scholar
  14. 14.
    Edbrooke DL, Newby DM, Mather SJ, Dixon AM, Hebron BS (1982) Safer sedation for ventilated patients. A new application for etomidate. Anaesthesia 37:365–371CrossRefGoogle Scholar
  15. 15.
    Ledingham IMcA, Watt I (1983) Influence of sedation on mortality in critically ill multiple trauma patients. Lancet 1:1270Google Scholar
  16. 16.
    Fellows IW, Bastow MD, Byrne AJ, Allison SP (1983) Adrenocortical suppression in multiple injuried patients: a complication of etomidate treatment. Br Med J 287:1835–1837CrossRefGoogle Scholar
  17. 17.
    Scott DB, Beamish D, Hudson IN, Jostel KG (1981) Prolonged infusion of chlormethiazole for basal sedation. Br J Anaesth 53:1203–1210CrossRefGoogle Scholar
  18. 18.
    Beller JP, Pottecher T, Lugnier A, Mangin P, Otteni JC (1988) Prolonged sedation with propofol in ICU patients: recovery and blood concentration changes during periodic interruptions in infusion. Br J Anaesth 61:583–588PubMedCrossRefGoogle Scholar
  19. 19.
    Bion JF, Logan BK, Newman PM, et al (1986) Sedation in intensive care: morphine and renal function. Intensive Care Med 12:359–365PubMedCrossRefGoogle Scholar
  20. 20.
    Green DW (1981) Severe cardiovascular collapse following phenoperidine. Anaesthesia 36:617–619PubMedCrossRefGoogle Scholar
  21. 21.
    Cohen AT, Kelly DR (1987) Assessment of alfentanil by intravenous infusion as long-term sedation in intensive care. Anaesthesia 42:545–548PubMedCrossRefGoogle Scholar
  22. 22.
    Duvaldestin P, Gibert C, Henzel D, Guy P, Desmonts JM (1979) Pancuronium blood level monitoring in patients with tetanus. Intensive Care Med 5:111–114PubMedCrossRefGoogle Scholar
  23. 23.
    Parker CJR, Jones JE, Hunter JM (1988) Disposition of infusions of atracurium and its metabolite, laudanasine, in patients in renal and respiratory failure in ITU. Br J Anaesth 61:531–540PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • J. M. Desmonts
  • A. Fichelle

There are no affiliations available

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