课件：ICU镇静镇痛与肌松胡文能.ppt

* * * * Patients admitted to the intensive care unit (ICU) for medical reasons or after surgery generally require sedation to minimise distress due to pain, discomfort and anxiety, to facilitate mechanical ventilation and nursing procedures, and to encourage a normal sleep/wake pattern. Inadequately treated discomfort and agitation can have detrimental medical consequences such as tachycardia, hypertension, myocardial ischaemia and increased oxygen consumption. A sedative agent ideally should have a rapid onset and short duration of action which allows easier titration to and maintenance of the desired level of sedation and quicker emergence from sedation. The ideal sedative would be eliminated by pathways not associated with renal, hepatic or pulmonary function. It would also have minimal depressant effects on the respiratory and cardiovascular system and would not affect the metabolism of other drugs. * * * * * * * Propofol 2% is a ‘double-strength’ formulation of Propofol containing 20 mg/ml propofol compared with Propofol 1% which contains 10 mg/ml propofol. Critically ill patients and patients with sepsis may have an impaired ability to metabolise lipids because of altered enzyme or metabolic pathways and may not be able to tolerate an excessive lipid load.1 A ‘double-strength’ formulation of Propofol (Propofol 2%) would allow the lipid load to be reduced by 50%. Certain types of patients require restriction of fluids as part of their clinical management. These include patients with trauma, sepsis, renal failure, hepatic failure, cardiac failure and head injuries. The development of a ‘double-strength’ formulation of Propofol (Propofol 2%) would enable the fluid volume given to be reduced by 50%. Nursing staff in the ICU may have many patients who require prolonged sedation. As Propofol is usually administered using a syringe pump or volumetric pump, frequent changes of syringes or vials may be necessary, particularly in those patients requiring high rat