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Sedation

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Andrew Ferguson
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Sedation, Analgesia, and Neuromuscular Blockade in the Adult ICU Giuditta Angelini, MD University of Wisconsin Madison, WI Gil Fraser, PharmD, FCCM Maine Medical Center Portland, ME Doug Coursin, MD, FCCM University of Wisconsin Madison, WI
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What We Know About ICU Agitation/Discomfort ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recall in the ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appropriate Recall May be Important ,[object Object],[object Object],[object Object]
Daily Goal is Arousable, Comfortable Sedation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Protocols and Assessment Tools ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sedating/Analgesia Options ,[object Object],[object Object],[object Object]
Overview of SCCM Algorithm 1 2 3 4 Jacobi J, Fraser GL, Coursin D, et al. Crit Care Med. 2002;30:119-141.
Address Pain
Opiates ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opiate Analgesic Options: Fentanyl, Morphine, Hydromorphone * Offset prolonged after long-term use ** Active metabolite accumulation causes excessive narcosis 10 mg 1.5 mg 100 mcg Equivalent doses X Avoid in hemodynamic instability X Preload reduction X** Avoid in renal disease X* Rapid offset X Rapid onset Morphine Hydromorphone Fentanyl
Sample Analgesia Protocol Numeric Rating Scale
Address Sedation Yes
Sedation Options: Benzodiazepines (Midazolam and Lorazepam) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sedation Options: Propofol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sample Sedation Protocol Sedation-agitation Scale Riker RR et al. Crit Care Med. 1999;27:1325.
Sedation Options: Dexmedetomidine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opiate and Benzodiazepine Withdrawal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Significance of ICU Delirium ,[object Object],[object Object],[object Object],[object Object],[object Object]
Delirium ,[object Object],[object Object],[object Object],[object Object],or Courtesy of W Ely, MD 3. Disorganized Thinking 4. Altered level of consciousness
Risk Factors for Delirium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Tools: ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delirium Screening Checklist ,[object Object],[object Object],Bergeron. Intensive Care Med. 2001;27:859.
Treatment of Delirium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Haloperidol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Atypical Antipsychotics: Quetiapine, Olanzapine, Risperidone, Ziprasidone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neuromuscular Blockade (NMB) (Paralytics) in the Adult ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neuromuscular Blockade in the ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neuromuscular Blocking Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quick Onset Muscle Relaxants for Intubation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Potential Contraindications of Succinylcholine ,[object Object],[object Object],[object Object],[object Object]
Neuromuscular Blocking Agents ,[object Object],[object Object],[object Object],[object Object],[object Object]
Neuromuscular Blocking Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Monitoring NMBAs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Monitoring Sedation During Paralysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of Neuromuscular Blocking Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sample NMBA Protocol
References ,[object Object],[object Object],[object Object],[object Object]
Case Scenario #1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Scenario #1 - Answer ,[object Object],[object Object],[object Object],[object Object]
Case Scenario #2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Scenario #2 - Answer ,[object Object],[object Object],[object Object],[object Object]
Case Scenario #3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Scenario #3 - Answer ,[object Object],[object Object],[object Object]

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Intravenous Anaesthetics
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Predicting fluid response in the ICU
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ICU topics for Final FRCA
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Orientation To The Icu
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Sedation

  • 1. Sedation, Analgesia, and Neuromuscular Blockade in the Adult ICU Giuditta Angelini, MD University of Wisconsin Madison, WI Gil Fraser, PharmD, FCCM Maine Medical Center Portland, ME Doug Coursin, MD, FCCM University of Wisconsin Madison, WI
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  • 9. Overview of SCCM Algorithm 1 2 3 4 Jacobi J, Fraser GL, Coursin D, et al. Crit Care Med. 2002;30:119-141.
  • 11.
  • 12. Opiate Analgesic Options: Fentanyl, Morphine, Hydromorphone * Offset prolonged after long-term use ** Active metabolite accumulation causes excessive narcosis 10 mg 1.5 mg 100 mcg Equivalent doses X Avoid in hemodynamic instability X Preload reduction X** Avoid in renal disease X* Rapid offset X Rapid onset Morphine Hydromorphone Fentanyl
  • 13. Sample Analgesia Protocol Numeric Rating Scale
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  • 17. Sample Sedation Protocol Sedation-agitation Scale Riker RR et al. Crit Care Med. 1999;27:1325.
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