Sedation and Analgesia

2017 ◽  
Author(s):  
Iskra I. Ivanova ◽  
Lynn D. Martin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care ◽  
Neuromuscular Blocking ◽  
Muscle Relaxants ◽  
Neuromuscular Blocking Agents ◽  
Essential Information ◽  
Sedation And Analgesia ◽  
American Society ◽  
American Society Of Anesthesiologists

This chapter on sedation and analgesia provides essential information on how to achieve and monitor the comfort of patients safely in the pediatric intensive care unit. Included is succinct information about dosing, pharmacodynamics, and pharmacokinetics of benzodiazepines, opiates, and other sedatives (propofol, etomidate, ketamine, dexmedetomidine, and nonsteroidal anti-inflammatory agents), as well as the antagonists naloxone and flumazenil. Information is also provided about the use and dosage of both depolarizing and nondepolarizing neuromuscular blocking agents (muscle relaxants) and American Society of Anesthesiologists guidelines for fasting (i.e., nothing by mouth) times before elective endotracheal intubation. The chapter also includes key information regarding the recognition and treatment of malignant hyperthermia.

scholarly journals Safety and efficacy of non-anesthesiologist administration of propofol sedation during esophagogastroduodenoscopy in the intensive care unit

2019 ◽  
Vol 07 (04) ◽  
pp. E625-E629
Author(s):  
Janaki Patel ◽  
John Fang ◽  
Linda Taylor ◽  
Douglas Adler ◽  
Andrew Gawron
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ambulatory Setting ◽  
Successful Completion ◽  
Icu Patients ◽  
Safety And Efficacy ◽  
Endoscopic Procedures ◽  
Propofol Sedation ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background and study aims Propofol sedation is an increasingly popular method of sedation for gastrointestinal endoscopic procedures. The safety and efficacy of the non-anesthesiologist administration of propofol (NAAP) sedation has been demonstrated in the ambulatory setting. However, NAAP sedation in intensive care unit (ICU) patients has not been reported. The purpose of this study is to determine safety and efficacy of NAAP sedation in an ICU population. Methods We retrospectively reviewed esophagogastroduodenoscopies (EGD) performed with NAAP sedation in our intensive care units from June 2014 to September 2016. All EGDs were performed for evaluation of gastrointestinal bleeding. The primary end point of this study was to analyze the incidence of sedation-related adverse events (AEs). The secondary end points included successful completion of procedure and any endoscopic interventions performed. Results Two of 161 procedures (1.2 %) had sedation-related AEs requiring procedure termination. One hundred forty-six of 161 procedures (90.7 %) were successfully completed. Incomplete procedures were due to excess heme, retained food or obstructive lesions (13/161, 8.1 %). Endoscopic intervention was performed successfully in 17/24 cases (70.8 %) that had endoscopically treated lesions identified. One hundred six of 161 patients (66 %) were American Society of Anesthesiologists (ASA) classification III or IV. Conclusion Our retrospective analysis demonstrated that EGDs can be successfully completed in ICU patients using NAAP sedation. When procedures cannot be completed, it is rarely due to sedation-related AEs. NAAP sedation further allows adequate examination and successful treatment of high-risk lesions. NAAP sedation appears safe and effective for endoscopic procedures in the ICU setting.

scholarly journals Anesthesia for an emergency gastrorrhagia operation in a patient suspected with COVID-19: a case report

2020 ◽  
Author(s):  
Yu Chen ◽  
Hao Lv
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Emergency Operation ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Suspected Case ◽  
Protective Measures ◽  
Gastric Hemorrhage ◽  
Protective Gear ◽  
Isolation Ward

Abstract BackgroundThe spread of the Coronavirus Disease 2019 (COVID-19) in China since December 2019 was very grave. According to Chinese govenment's guidelines, patients can be divided into confirmed cases and suspected cases. The protective measures for both are the same.Case summaryWe report a case of an emergency gastrorrhagia operation for a patient suspected to have contracted COVID-19. A 54-year-old man with massive gastric hemorrhage was scheduled for an emergency operation for exploratory hemostasis. COVID-19 infection, however, could not be ruled out, and the patient was treated as a suspected case. All the protective measures were based on patients infected or suspected to be infected with COVID-19. Before the operation, we carried out a series of protective measures, such as preparing the operating room and wearing personal protective gear. We increased the dose of neuromuscular blocking agents during the induction of anesthesia to prevent the splashing of secretions by coughing. The operation went smoothly, and the patient was transferred to an intensive care unit (ICU) in the isolation ward for extubation. Seven days later, the patient was ruled out for COVID-19 infection. ConclusionThe patient recovered successfully from the massive gastric hemorrhage, and the medical staff were not infected.

Use of Neuromuscular Blocking Agents in the Intensive Care Unit

2010 ◽  
pp. 1155-1172
Author(s):  
Rodger E. Barnette ◽  
Ihab R. Kamel ◽  
Lilibeth Fermin ◽  
Gerard J. Criner
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Blocking Agents
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