Sedation of the critically ill patient:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | Undetermined |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1995
|
| Schriftenreihe: | Critical care clinics
11,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | VIII S., S. 791 - 1039 graph. Darst. |
Internformat
MARC
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Datensatz im Suchindex
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| adam_text | SEDATION OF THE CRITICALLY ILL PATIENT
CONTENTS
Preface ix
Eugene Y. Cheng
Patients Requiring Sedation 791
Avery Tung and Myer Rosenthal
Recent advances in the pharmacology of sedative drugs have
expanded their use in the intensive care unit. Indications and
endpoints for sedation, however, often are defined poorly and
are difficult to assess. Nevertheless, the complications of sedative
drug administration are real. New indications for sedation have
been proposed in recent years, including enforcing sleep/wake
cycles, manipulating cellular metabolism, and preventing myo
cardial ischemia. The evidence supporting the efficacy of these
new indications is not yet complete.
Methods for Monitoring the Level of Sedation 803
Michail N. Avramov and Paul F. White
Sedative drugs commonly are titrated to effect in critically ill
patients. Subjective clinical assessment tools are used to deter¬
mine the patient s level of sedation, and there clearly is a need
for improved quantitative methods of monitoring sedation. This
article describes the current methods for assessing the level of
sedation in critically ill patients and discusses the potential role
of neurophysiologic monitoring using processed electroencepha¬
lograms and evoked potentials.
Optimal Intravenous Dosing Strategies for Sedatives and
Analgesics in the Intensive Care Unit 827
Juliana Barr and Andrew Donner
Critically ill patients typically receive intravenous opioids and
sedative hypnotics in the intensive care unit (ICU) to minimize
CRITICAL CARE CLINICS VOLUME 11 • NUMBER 4 • OCTOBER 1995 V
physical and psychological discomfort. Inadequate dosing of sed¬
atives and analgesics in the ICU may lead to unwanted agitation,
decannulation, and cardiopulmonary instability. Excessive dosing
of these medications may lead to respiratory depression, systemic
hypotension, and prolonged sedation after discontinuation. This
article attempts to define intravenous dosing strategies for opi
oids and sedative hypnotics commonly administered to ICU pa¬
tients.
Opioids and Benzodiazepines 849
Michael J. Murray, Martin L. DeRuyter, and
Barry A. Harrison
Most patients in the intensive care unit experience pain and
anxiety, which are treated most commonly with an opioid or a
benzodiazepine. These compounds are effective and have a well
established safety record. With the exception of associated respi¬
ratory depression, they have a relatively wide therapeutic win¬
dow. New approaches and formulations for opioids and benzodi¬
azepines are being used with continued success in the clinical
setting.
Barbiturates, Neuroleptics, and Propofol for Sedation 875
Niels Lund and Peter J. Papadakos
In a modern, hectic, and stressful intensive care unit, sedation is
an important aspect of care, and every nurse and physician in a
critical care setting must be familiar with it. This article describes
older modalities of sedation, including barbiturates and neurolep¬
tics, and compares them to a more recently developed drug,
propofol.
Inhalational Anesthetics in the Intensive Care Unit 887
K. L. Kong
Intravenous (IV) sedation is convenient, and many different IV
agents are used. They are not always effective, however, and
there are disadvantages to every intravenous agent used in clini¬
cal practice. Inhalational anesthetics are a useful alternative and
have specific advantages. Further technologic refinements in the
technique of inhalational sedation of mechanically ventilated pa¬
tients may lead to wider clinical applications.
Advantages and Disadvantages of Combining
Sedative Agents 903
Daniel P. Stoltzfus
One advantage of combination sedative therapy is the use of
small doses of agents from different drug classes to treat concomi¬
tant behavioral problems. The simultaneous use of multiple seda¬
tive agents results in the need for new clinical decisions regarding
Vi CONTENTS
the administration of and weaning from the pharmacologic effects
of these drugs. This article reviews the current status of research
regarding combination sedative therapy.
Sedation of the Agitated, Critically 111 Patient Without an
Artificial Airway 913
Charles G. Durbin, Jr
Sedation of the critically ill patient without an artificial airway is
a difficult and challenging clinical problem. Careful attention to
preparations, selection of appropriate techniques, and monitoring
of patient responses during sedation will reduce problems in
this patient population. Preparation to provide airway support is
essential in the sedation of these patients, and the appropriate
training of the clinician is important.
Sedation for the Mechanically Ventilated Patient 937
Anthony J. Mazzeo
This article discusses the potential benefits of sedation for the
mechanically ventilated patient. These benefits include the allevi¬
ation of anxiety and pain, which may result in a reduction of
oxygen consumption. Other advantages include improved syn¬
chronization of a patient s breathing pattern with ventilator set¬
tings and better patient care, comfort, and safety. The patient s
clinical situation, such as respiratory failure caused by right to
left shunt, cardiovascular problems, elevated intracranial pres¬
sure, hepatic disease, and renal failure, needs to be considered
when selecting a sedative agent.
Use of Neuromuscular Blocking Drugs in the
Critically 111 Patient 957
Douglas B. Coursin and Richard C. Prielipp
Neuromuscular blocking drugs are used routinely to facilitate the
care of critically ill patients of all ages. This article addresses
current uses and concerns about the appropriate administration
of these drugs. Several important topics are highlighted, includ¬
ing basic physiology of neuromuscular transmission, blocker
pharmacology, drug selection, monitoring, and future areas of re¬
search.
Complications Associated with Sedative and Neuromuscular
Blocking Drugs in Critically 111 Patients 983
Richard C. Prielipp, Douglas B. Coursin, Kenneth E. Wood,
and Michael J. Murray
Sedative and neuromuscular blocking (NMB) drugs may be life
saving when given to intensive care unit (ICU) patients with
certain medical conditions. Because of this, their use has increased
CONTENTS vii
recently. Sedative and NMB drugs are administered often to
patients with severe concurrent organ dysfunction; however,
there is increased recognition of unexpected complications associ¬
ated with the prolonged administration of these drugs. An under¬
standing of the potential side effects is crucial if sedative and
NMB drugs are used to manage patients in the ICU.
The Cost of Sedating and Paralyzing the Critically 111 Patient 1005
Eugene Y. Cheng
Unless the health care industry becomes more cost effective, ap¬
proximately 25% of the gross domestic product in the United
States will be consumed by health care by the year 2050. Intensive
care units (ICUs) are among the costliest areas of the hospital.
This article describes several strategies to reduce overall drug
costs in the ICU, including reducing acquisition costs, using ge¬
neric brands when feasible, and educating physicians in drug
cost efficiency, appropriate drug selection, dosing intervals, and
administration levels.
Cumulative Index 1995 1021
Subscription Information Inside back cover
Viii CONTENTS
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| publishDate | 1995 |
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| series | Critical care clinics |
| series2 | Critical care clinics |
| spelling | Sedation of the critically ill patient Eugene Y. Cheng, guest ed. Philadelphia [u.a.] Saunders 1995 VIII S., S. 791 - 1039 graph. Darst. txt rdacontent n rdamedia nc rdacarrier Critical care clinics 11,4 Schwerkranker (DE-588)4180512-4 gnd rswk-swf Intensivtherapie (DE-588)4027258-8 gnd rswk-swf Sedierung (DE-588)4180607-4 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Sedierung (DE-588)4180607-4 s Schwerkranker (DE-588)4180512-4 s DE-604 Intensivtherapie (DE-588)4027258-8 s Cheng, Eugene Y. Sonstige oth Critical care clinics 11,4 (DE-604)BV000019838 11,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007011334&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Sedation of the critically ill patient Critical care clinics Schwerkranker (DE-588)4180512-4 gnd Intensivtherapie (DE-588)4027258-8 gnd Sedierung (DE-588)4180607-4 gnd |
| subject_GND | (DE-588)4180512-4 (DE-588)4027258-8 (DE-588)4180607-4 (DE-588)4143413-4 |
| title | Sedation of the critically ill patient |
| title_auth | Sedation of the critically ill patient |
| title_exact_search | Sedation of the critically ill patient |
| title_full | Sedation of the critically ill patient Eugene Y. Cheng, guest ed. |
| title_fullStr | Sedation of the critically ill patient Eugene Y. Cheng, guest ed. |
| title_full_unstemmed | Sedation of the critically ill patient Eugene Y. Cheng, guest ed. |
| title_short | Sedation of the critically ill patient |
| title_sort | sedation of the critically ill patient |
| topic | Schwerkranker (DE-588)4180512-4 gnd Intensivtherapie (DE-588)4027258-8 gnd Sedierung (DE-588)4180607-4 gnd |
| topic_facet | Schwerkranker Intensivtherapie Sedierung Aufsatzsammlung |
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