sedation in traumatic brain injury镇静在创伤性脑损伤.pdfVIP

Hindawi Publishing Corporation Emergency Medicine International Volume 2012, Article ID 637171, 11 pages doi:10.1155/2012/637171 Review Article Sedation in Traumatic Brain Injury Oliver Flower1, 2 and Simon Hellings2 1 University of Sydney, Sydney, NSW, Australia 2 Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW 2065, Australia Correspondence should be addressed to Simon Hellings, simonhellings@ Received 8 March 2012; Revised 16 May 2012; Accepted 22 June 2012 Academic Editor: William A. Knight IV Copyright © 2012 O. Flower and S. Hellings. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Several different classes of sedative agents are used in the management of patients with traumatic brain injury (TBI). These agents are used at induction of anaesthesia, to maintain sedation, to reduce elevated intracranial pressure, to terminate seizure activity and facilitate ventilation. The intent of their use is to prevent secondary brain injury by facilitating and optimising ventilation, reducing cerebral metabolic rate and reducing intracranial pressure. There is limited evidence available as to the best choice of sedative agents in TBI, with each agent having specific advantages and disadvantages. This review discusses these agents and offers evidence-based guidance as to the appropriate context in which each agent may be used. Propofol, benzodiazepines, narcotics, barbiturates, etomidate, ketamine, and dexmedetomidine are reviewed and compared. 1. Introduction flow (CBF), and intracranial pressure (ICP). See Table 1