SEDATIONandANALGESIAinthePICU[镇静镇痛在PICU](PPT-41).pptVIP

SEDATION and ANALGESIA in the PICU GOALS Analgesia for painful diseases and procedures Compliance with controlled ventilation and routine intensive care Amnesia for the periods of sedation Reduce the physiological responses to stress Avoid complication SEDATION and ANALGESIA Inadequate analgesia and postsurgical stress response is a metabolic, humoral, and hemodynamic response following injury or surgery This neuroendocrine cascade leads to increased oxygen consumption, increased carbon dioxide production, and a generalized catabolic state with a negative nitrogen balance SEDATION/ANALGESIA Sedation (seda/shun) [L. sedatio, to calm, allay]. The act of calming, especially by the administration of a sedative, or the state of being calm. Analgesia (an-al-je/zi-ah) [G. insensibility, from an - privative,negative + algesis, sensation of pain] A condition in which nocioceptive stimuli are perceived but are not interpreted as pain; usually accompanied by sedation without loss of consciousness. IDEAL PICU SEDATIVE/ANALGESIA Rapid onset Predictable duration No active metabolites Rapid recovery Multiple routes of delivery Easy to titrate Minimal cardiopulmonary effects Not altered by renal or hepatic disease No drug interactions Wide therapeutic index COMMON DRUGS UTILIZED Opiates (Narcotics) Benzodiazepines Chloral hydrate Barbiturates Ketamine Propofol Neuroleptics Paralytics SITUATIONS REQUIRING SEDATIVES/ANALGESIA MECHANICAL VENTILATION Respiratory failure Airway Neurological POST OPERATIVE HEAD INJURY PULMONARY HYPERTENSION PROCEDURES OPIOIDS First line drugs Provide analgesia and sedation, NOT amnesia Act similarly as a class Produce delayed gastric emptying, decreased intestinal peristalsis, and urinary retention Narcotic to be used: Morphine Fentanyl Methadone OPIOIDS ROUTE OF ADMINISTRATION IV Oral Transmucosal Transdermal MODE OF ADMINISTRATION Intermittent/on demand (as necessary) Fixed interval Continuous infusion PCA MORPHINE Gold standard Hepatic metaboli