sedationandanalgesiainthepicu[镇静镇痛在picu](ppt-41)

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1、SEDATIONandANALGESIAinthePICUGOALSAnalgesiaforpainfuldiseasesandproceduresCompliancewithcontrolledventilationandroutineintensivecareAmnesiafortheperiodsofsedationReducethephysiologicalresponsestostressAvoidcomplicationSEDATIONandANALGESIAInadequateanalgesiaandposts

2、urgicalstressresponseisametabolic,humoral,andhemodynamicresponsefollowinginjuryorsurgeryThisneuroendocrinecascadeleadstoincreasedoxygenconsumption,increasedcarbondioxideproduction,andageneralizedcatabolicstatewithanegativenitrogenbalanceSEDATION/ANALGESIASedation(s

3、eda/shun)[L.sedatio,tocalm,allay].Theactofcalming,especiallybytheadministrationofasedative,orthestateofbeingcalm.Analgesia(an-al-je/zi-ah)[G.insensibility,froman-privative,negative+algesis,sensationofpain]Aconditioninwhichnocioceptivestimuliareperceivedbutarenotint

4、erpretedaspain;usuallyaccompaniedbysedationwithoutlossofconsciousness.IDEALPICUSEDATIVE/ANALGESIARapidonsetPredictabledurationNoactivemetabolitesRapidrecoveryMultipleroutesofdeliveryEasytotitrateMinimalcardiopulmonaryeffectsNotalteredbyrenalorhepaticdiseaseNodrugin

5、teractionsWidetherapeuticindexCOMMONDRUGSUTILIZEDOpiates(Narcotics)BenzodiazepinesChloralhydrateBarbituratesKetaminePropofolNeurolepticsParalyticsSITUATIONSREQUIRINGSEDATIVES/ANALGESIAMECHANICALVENTILATIONRespiratoryfailureAirwayNeurologicalPOSTOPERATIVEHEADINJURYP

6、ULMONARYHYPERTENSIONPROCEDURESOPIOIDSFirstlinedrugsProvideanalgesiaandsedation,NOTamnesiaActsimilarlyasaclassProducedelayedgastricemptying,decreasedintestinalperistalsis,andurinaryretentionNarcotictobeused:MorphineFentanylMethadoneOPIOIDSROUTEOFADMINISTRATIONIVOral

7、TransmucosalTransdermalMODEOFADMINISTRATIONIntermittent/ondemand(asnecessary)FixedintervalContinuousinfusionPCAMORPHINEGoldstandardHepaticmetabolismDepressesrespirationbyalteringchemoreceptorsensitivitytoCO2DepressesrateovertidalvolumeDecreasessighfrequencyCancause

8、hypotensionduetohistaminemediatedvasodilationCanblockcompensatorycatecholamineeffectProlongedclearanceinneonatesMORPHINEIVintermittent0.1mg/kgq3-