Sedation, analgesia, and neuromuscular blockers in critical care medicine:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2001
|
| Schriftenreihe: | Critical care clinics
17,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII S., S. 821 - 1046 graph. Darst. |
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| 245 | 1 | 0 | |a Sedation, analgesia, and neuromuscular blockers in critical care medicine |c Jeffrey S. Vender ..., guest eds. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2001 | |
| 300 | |a XII S., S. 821 - 1046 |b graph. Darst. | ||
| 336 | |b txt |2 rdacontent | ||
| 337 | |b n |2 rdamedia | ||
| 338 | |b nc |2 rdacarrier | ||
| 490 | 1 | |a Critical care clinics |v 17,4 | |
| 650 | 7 | |a Analgesie |2 gtt | |
| 650 | 7 | |a Anesthesie |2 gtt | |
| 650 | 7 | |a Intensive care |2 gtt | |
| 650 | 4 | |a Analgesia | |
| 650 | 4 | |a Central Nervous System Agents | |
| 650 | 4 | |a Conscious Sedation | |
| 650 | 4 | |a Critical Care |x trends | |
| 650 | 4 | |a Neuromuscular Blocking Agents | |
| 650 | 4 | |a Pain |x prevention & control | |
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Datensatz im Suchindex
| _version_ | 1804128920266604544 |
|---|---|
| adam_text | SEDATION, ANALGESIA, AND NEUROMUSCULAR
BLOCKERS IN CRITICAL CARE MEDICINE
CONTENTS
Preface xi
Jeffery S. Vender, Joseph W. Szokol, and Glenn S. Murphy
Anxiety, Delirium, and Pain in the Intensive Care Unit 821
Joseph W. Szokol and Jeffery S. Vender
Anxiety and delirium are common manifestations in the intensive
care unit (ICU). Their recognition and treatment are vital for
the well being of the patient. Pain is also a commonly reported
condition in ICU patients and often is undertreated. The under
treatment of pain can lead to significant physiologic and psy¬
chologic adverse outcomes.
Ben/odiazepines in the Intensive Care Unit 843
Christopher C. Young and Richard C. Prielipp
Intensive care unit (ICU) patients and their families, nurses, insur¬
ers, and health care regulators are demanding that sedation for
ICU patients be improved to optimize anxiolysis and analgesia
without delaying ventilator weaning or prolonging the ICU
length of stay. Algorithms target pharmacodynamic criteria
guided by standardized clinical scales such as those by Ramsay
and Riker to ensure consistent, targeted sedation end points.
Savvy clinicians already rely on synergistic combination of ago¬
nists at the v aminobutyric acid (GABA B) receptor, the c 2 recep¬
tor, and the various opioid receptors to achieve these effects.
Future applications will titrate drugs to even more refined end
points and simultaneously will address issues such as sleep depri¬
vation in ICU patents and psychologic stress disorders in long
term ICU survivors.
CRITICAL CARE CLINICS
VOLUME 17 • NUMBER 4 • OCTOBER 2001 vii
Use of Propofol and Other Nortbenzodiazepirte
Sedatives in the Intensive Care Unit 863
Giuditta Angelini, Jonathan T. Ketzler,
and Douglas B. Coursin
Propofol is the main sedative alternative to benzodiazepines in
critically ill patients. It has a rapid onset and offset and is readily
titratable, and its use has not been associated with withdrawal.
Propofol bolus administration results in hypotension, and it must
be initiated with care in critical care patients who are hemody
namically unstable or potentially hypovolemic. Other less fre¬
quently administered nonbenzodiazepine sedatives, including
etomidate, ketamine, barbiturates, dexmedetomidine, and halo
peridol, are discussed briefly.
New Agents for Sedation in the Intensive Care Unit 881
Mervyn Maze, Chiara Scarfini, and Franco Cavaliere
The introduction of two new drugs, dexmedetomidine and remi
fentanil, and the renewed interest in lorazepam characterize re¬
cent developments in intensive care unit sedation. Different end
points are provided by these drugs, including cooperative seda¬
tion (dexmedetomidine), effective and titratable analgesia while
mitigating the risk of prolonged respiratory depression (remifen
tanil), and cost savings by accepting a slower onset of action
(lorazepam).
Analgesic Agents: Pharmacology and Application in
Critical Care 899
Lisa G. Hall, Lance J. Oyen, and Michael J. Murray
Evaluation of analgesic agents is multifactorial. The authors know
of no direct comparisons among the choices in analgesic agents
that suggest one therapy over another in global outcomes such
as mortality or morbidity. Therefore, until further outcome differ¬
entiation between agents is proved, understanding the primary
difference of delivery routes, mechanisms of action, pharmacoki
netics, and adverse effects serves as the best guide for selecting
the appropriate agent for each patient.
Neuromuscular Blocking Drugs: Use and Misuse in the
Intensive Care Unit 925
Glenn S. Murphy and Jeffery S. Vender
Long term neuromuscular blockade is occasionally necessary in
the intensive care unit setting. Numerous complications that re¬
quire neuromuscular blocking agents can occur in the critically ill
patient. The development of prolonged muscular weakness after
the use of nondepolarizing muscle relaxants is a frequent compli
viii CONTENTS
cation and is attributed to various pharmacokinetic factors and
to the development of functional alterations in the nerves, mus¬
cles, or neuromuscular junctions of the motor unit. The choice
of neuromuscular blocking drug does not seem to influence the
occurrence of this complication. Clinicians can minimize morbid¬
ity associated with prolonged neuromuscular blockades by care¬
fully assessing each patient and using the smallest possible doses
of the drug allowed for patient care.
Regional Analgesia in the Intensive Care Unit:
Principles and Practice 943
Frank Clark and Hugh C. Gilbert
Regional analgesia can be a useful means of controlling pain in
the intensive care unit. This article explores the basic mechanisms
of nociception and presents a summary of some of the regional
analgesic techniques available to the intensivist. Used appropri¬
ately, regional analgesia provides good pain control and may
improve patient outcome.
Monitoring Sedation, Agitation, Analgesia, and
Delirium in Critically 111 Adult Patients 967
Gilles L. Fraser and Richard R. Riker
The development and testing of assessment tools to monitor
intensive care unit (ICU) agitation, sedation, analgesic needs, and
delirium represent an essential first step toward making the ICU
a more humane environment. Data suggest that use of these
assessment tools improves outcomes and that their use should be
incorporated routinely in the care of the critically ill. In this
article, recent developments in this topic are discussed, including
the newly developed tools shown to be valid and reliable in
the ICU.
Using Protocols to Improve the Outcomes of
Mechanically Ventilated Patients: Focus on Weaning
and Sedation 989
Emad H. Ibrahim and Marin H. Kollef
Intensive care units (ICUs) are complex environments with tre¬
mendous amounts of information for clinicians to process. Proto¬
cols and guidelines are tools that can assist clinicians in carrying
out important tasks for their critically ill patients. The use of
selected protocols and guidelines in the ICU setting has been
demonstrated to improve patient outcomes and to reduce medical
care costs. Intensive care unit clinicians should consider the use
of specific protocols or guidelines in their individual units, partic¬
ularly if these protocols or guidelines can be shown to improve
on existing practices.
CONTENTS *X
Analysis of Pharmacoeconomics of Sedation
and Analgesia 1003
Eric T. Wittbrodt
Intravenous sedation and analgesia are cornerstones of the phar
macologic management of the critically ill, mechanically venti¬
lated adult patient. No conclusive evidence exists to support any
single optimal sedative or analgesic regimen in this heteroge¬
neous population. The role of cost effectiveness in the process of
selecting a regimen is explored with a review of the literature,
followed by proposed cost effectiveness models and recommen¬
dations for the clinical practitioner.
Commentary: Balancing Sedation and Analgesia in the
Critically 111 1015
Gilbert Park, Douglas B. Coursin, E. Wesley Ely,
Michael England, Gilles L. Fraser, Jean Mantz,
Sharon McKinley, Michael Ramsay, Jens Scholz,
Mervyn Singer, Robert Sladen, Jeffery S. Vender,
and Lorie Wild
Critically ill patients frequently receive sedatives and analgesics
as intermittent bolus injections or continuous intravenous infu¬
sions. Sedatives are used to calm patients pharmacologically, re¬
lieve anxiety, and, at times, treat agitation or delirium. Analgesic
agents provide pain relief from primary pathologies or secondary
insults (e.g., discomfort associated with bedside care or the use
of various support devices, such as mechanical ventilation or
during invasive procedures). Increasing recognition of the risks
and benefits of sedative and analgesic use lead to refinement of
guidelines to optimize their safe and appropriate application. The
authors present a multidisciplinary overview that promotes a
generic approach to sedation and analgesia in the critically ill.
They emphasize the need for assessment of patients, preferably
with standardized subjective and objective criteria, with continual
reassessment, and with the appropriate use of pharmacologic and
nonpharmacologic techniques to provide patient comfort.
Cumulative Index 1029
Subscription Information Inside Back Cover
X CONTENTS
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| spelling | Sedation, analgesia, and neuromuscular blockers in critical care medicine Jeffrey S. Vender ..., guest eds. Philadelphia [u.a.] Saunders 2001 XII S., S. 821 - 1046 graph. Darst. txt rdacontent n rdamedia nc rdacarrier Critical care clinics 17,4 Analgesie gtt Anesthesie gtt Intensive care gtt Analgesia Central Nervous System Agents Conscious Sedation Critical Care trends Neuromuscular Blocking Agents Pain prevention & control Intensivmedizin (DE-588)4027263-1 gnd rswk-swf Sedierung (DE-588)4180607-4 gnd rswk-swf Analgesie (DE-588)4001847-7 gnd rswk-swf Muskelrelaxans (DE-588)4040907-7 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Muskelrelaxans (DE-588)4040907-7 s Intensivmedizin (DE-588)4027263-1 s DE-604 Analgesie (DE-588)4001847-7 s Sedierung (DE-588)4180607-4 s Vender, Jeffrey S. Sonstige oth Critical care clinics 17,4 (DE-604)BV000019838 17,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009628134&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Sedation, analgesia, and neuromuscular blockers in critical care medicine Critical care clinics Analgesie gtt Anesthesie gtt Intensive care gtt Analgesia Central Nervous System Agents Conscious Sedation Critical Care trends Neuromuscular Blocking Agents Pain prevention & control Intensivmedizin (DE-588)4027263-1 gnd Sedierung (DE-588)4180607-4 gnd Analgesie (DE-588)4001847-7 gnd Muskelrelaxans (DE-588)4040907-7 gnd |
| subject_GND | (DE-588)4027263-1 (DE-588)4180607-4 (DE-588)4001847-7 (DE-588)4040907-7 (DE-588)4143413-4 |
| title | Sedation, analgesia, and neuromuscular blockers in critical care medicine |
| title_auth | Sedation, analgesia, and neuromuscular blockers in critical care medicine |
| title_exact_search | Sedation, analgesia, and neuromuscular blockers in critical care medicine |
| title_full | Sedation, analgesia, and neuromuscular blockers in critical care medicine Jeffrey S. Vender ..., guest eds. |
| title_fullStr | Sedation, analgesia, and neuromuscular blockers in critical care medicine Jeffrey S. Vender ..., guest eds. |
| title_full_unstemmed | Sedation, analgesia, and neuromuscular blockers in critical care medicine Jeffrey S. Vender ..., guest eds. |
| title_short | Sedation, analgesia, and neuromuscular blockers in critical care medicine |
| title_sort | sedation analgesia and neuromuscular blockers in critical care medicine |
| topic | Analgesie gtt Anesthesie gtt Intensive care gtt Analgesia Central Nervous System Agents Conscious Sedation Critical Care trends Neuromuscular Blocking Agents Pain prevention & control Intensivmedizin (DE-588)4027263-1 gnd Sedierung (DE-588)4180607-4 gnd Analgesie (DE-588)4001847-7 gnd Muskelrelaxans (DE-588)4040907-7 gnd |
| topic_facet | Analgesie Anesthesie Intensive care Analgesia Central Nervous System Agents Conscious Sedation Critical Care trends Neuromuscular Blocking Agents Pain prevention & control Intensivmedizin Sedierung Muskelrelaxans Aufsatzsammlung |
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