ICU止痛和镇静讲义.pptVIP

Rapid transient elevations in blood pressure Bradycardia and hypotension 学习文档 Adverse effects patients. Of greatest concern are respiratory, hemodynamic, central nervous system, and gastrointestinal effects. hypotension :the combination of sympatholysis,vagally mediated bradycardia,and histamine release(when using codeine,morphine, or meperidine) central nervous system :hallucinations may increase agitation insome patients. gastrointestinal effects :Routine prophylactic use of a stimulant laxative may minimize constipation.Small-bowel intubation may be needed for enteral nutrition because of gastric hypomotility (45). 学习文档 Opioid Administration Techniques. Bolus doses Intravenous administration intramuscular administration. a transdermal patch(on the permeability, temperature, perfusion, and thickness of the skin). Intramuscular administration is not recommended in hemodynamically unstable patients because of altered perfusion and variable absorption. Daily awakening 学习文档 The use of a reversal agent Naloxone , is not recommended because it can induce withdrawal and may cause nausea, cardiac stress, and arrhythmias. 学习文档 Recommendations: 1.A therapeutic plan and goal of analges(c) 2.intravenous doses of an opioid analgesic are required, fentanyl, hydromorphone,and morphine are the recommended agents. (c) 3. Scheduled opioid doses or a continuous infusion is preferred over an “as needed” regimen to ensure consistent analgesia.A PCA device may be utilized to deliver opioids if the patient is able to understand and operate the device. (b) 学习文档 4.Fentanyl is preferred for a rapid onset of analgesia in acutely distressed patients. (C) 5. Fentanyl or hydromorphone are preferred for patients with hemodynamic instability or renal insufficiency.(C) 6. Morphine and hydromorphone are preferred for intermittent therapy because of their longer duration of effect.(C) 学习文档 NSAIDs adverse effects, including gastrointestinal bleeding,bleeding secondary to platelet inhibition