| 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.nl
Crit 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 |
| Sedación y analgesia en terapia intensiva: una comparación entre fentanil y remifentanil |
Sedation and analgesia in intensive care: a comparison of fentanyl and remifentanil.
Cevik F, Celik M, Clark PM, Macit C.
Medical Department, Abbott Pharmaceuticals, Meral Plaza, Umraniye, Istanbul, Turkey.
Pain Res Treat. 2011;2011:650320. Epub 2011 Jul 2.
Abstract
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 significantly more 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.ncbi.nlm.nih.gov/pmc/articles/PMC3197257/pdf/PRT2011-650320.pdf |
| Análisis de costo-resultados de analgo-sedación basada con remifentanil vs. analgesia convencional y sedación para pacientes con ventilación mecánica en los países bajos |
Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands.
Al MJ, Hakkaart L, Tan SS, Bakker J.
Institute for Medical Technology Assessment, Erasmus University, Burg, Oudlaan 50, Rotterdam, 3062 PA, The Netherlands. al@bmg.eur.nl
Crit Care. 2010;14(6):R195. Epub 2010 Nov 1.
Abstract
INTRODUCTION: Hospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences of remifentanil-based analgo-sedation (RS) vs. conventional analgesia and sedation (CS) in patients requiring mechanical ventilation (MV) in the intensive care unit (ICU), using a modelling approach. METHODS: A Markov model was developed to describe patient flow in the ICU. The hourly probabilities to move from one state to another were derived from UltiSAFE, a Dutch clinical study involving ICU patients with an expected MV-time of two to three days requiring analgesia and sedation. Study medication was either: CS (morphine or fentanyl combined with propofol, midazolam or lorazepam) or: RS (remifentanil, combined with propofol when required). Study drug costs were derived from the trial, whereas all other ICU costs were estimated separately in a Dutch micro-costing study. All costs were measured from the hospital perspective (price level of 2006). Patients were followed in the model for 28 days. We also studied the sub-population where weaning had started within 72 hours. RESULTS: The average total 28-day costs were €15,626 with RS versus €17,100 with CS, meaning a difference in costs of €1474 (95% CI -2163, 5110). The average length-of-stay (LOS) in the ICU was 7.6 days in the RS group versus 8.5 days in the CS group (difference 1.0, 95% CI -0.7, 2.6), while the average MV time was 5.0 days for RS versus 6.0 days for CS. Similar differences were found in the subgroup analysis. CONCLUSIONS: Compared to CS, RS significantly decreases the overall costs in the ICU. TRIAL REGISTRATION: Clinicaltrials.gov NCT00158873.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219979/pdf/cc9313.pdf
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