| Medicamentos para analgesia y sedación en la unidad de terapia intensiva: una revisión |
Medications for analgesia and sedation in the intensive care unit: an overview. Gommers D, Bakker J. Department of Intensive Care, Erasmus MC, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. d.gommers@erasmusmc.nlCrit Care. 2008;12 Suppl 3:S4. Epub 2008 May 14.Abstract Critically ill patients are often treated with continuous intravenous infusions of sedative drugs. However, this is associated with high risk for over-sedation, which can result in prolonged stay in the intensive care unit. Recently introduced protocols (daily interruption and analgosedation) have proven to reduce the length of intensive care unit stay. To introduce these protocols, new agents or new regimens with the well established agents may be required. In this article we briefly discuss these new regimens and new agents, focusing on the short-acting substances. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2391270/pdf/cc6150.pdf |
| Manejo de la sedación en las unidades de cuidado intensivo en Australia y Nueva Zelanda: opiniones y práctica de médicos y enfermeras |
Sedation management in Australian and New Zealand intensive care units: doctors' and nurses' practices and opinions. O'Connor M, Bucknall T, Manias E. Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia. mar1oconnor2@yahoo.com.auAm J Crit Care. 2010 May;19(3):285-95. Epub 2009 Sep 21.Abstract OBJECTIVE: To explore the use of sedatives and analgesics, tools for scoring level of sedation, sedation and pain protocols, and daily interruptions in sedation in Australian and New Zealand intensive care units and to examine doctors' and nurses' opinions about the sedation management of critically ill patients. METHODS: A cross-sectional Internet-based survey design was used. In total, 2146 members of professional critical care organizations in Australia and New Zealand were e-mailed the survey during a 4-month period in 2006 through 2007. RESULTS: Of 348 members (16% response rate) who accessed the survey, 246 (71%) completed all sections. Morphine, fentanyl, midazolam, and propofol were the most commonly used medicines. Newer medicines, such as dexmedetomidine and remifentanil, and inhalant medications, such as nitrous oxide and isoflurane, were rarely used by most respondents. Respondents used protocols to manage sedatives (54%) and analgesics (51%), and sedation assessment tools were regularly used by 72%. A total of 62% reported daily interruption of sedation; 23% used daily interruption for more than 75% of patients. A disparity was evident between respondents' opinions on how deeply patients were usually sedated in practice and how deeply patients should ideally be sedated. CONCLUSIONS: Newer medications are used much less than are traditional sedatives and analgesics. Sedation protocols are increasingly used in Australasia, despite equivocal evidence supporting their use. Similarly, daily interruption of sedation is common in management of patients receiving mechanical ventilation. Research is needed to explore contextual and personal factors that may affect sedation management. http://ajcc.aacnjournals.org/content/19/3/285.full.pdf+html |
| Sedación y analgesia en terapia intensiva: compararación entre fenitanil y remifentanil |
Sedation and Analgesia in Intensive Care: A Comparison of Fentanyl and Remifentanil F. Cevik, M. Celik, P. M. Clark, and C.Macit Pain Research and Treatment Volume 2011, Article ID 650320, 9 pages doi:10.1155/2011/650320 Optimal sedation and analgesia are of key importance in intensive care. The aim of this study was to assess the quality of sedoanalgesia and outcome parameters in regimens containing midazolam and either fentanyl or remifentanil. A prospective, randomized, open-label, controlled trial was carried out in the ICU unit of a large teaching hospital in Istanbul over a 9-month period. Thirty-four patients were randomly allocated to receive either a remifentanil-midazolam regimen (R group, n = 17) or a fentanyl-midazolam regimen (F group, n = 17). A strong correlation between Riker Sedation-Agitation Scale (SAS) and Ramsey Scale (RS) measurements was observed. Comparatively, remifentanil provided significantlymore potent and rapid analgesia based on Behavioral-Physiological Scale (BPS) measurements and a statistically nonsignificantly shorter time to discharge. On the other hand, remifentanil also caused a significantly sharper fall in heart rate within the first six hours of treatment. http://www.hindawi.com/journals/prt/2011/650320/ |
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