Transcription of Sedation and Analgesia in the ICU
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Sedation and Analgesia in the ICU
Sedation in the ICUA ndrew Straznitskas, PharmD, BCCCPC linical Pharmacist, Medical ICUNYC H+H/BellevueContributors to ICU AgitationAgitationPainAnalgesicsAnxietyS edativesDeliriumNeurolepticsMethods to Identify Delirium Intensive Care Delirium Screening Checklist (ICDSC) Identify presence or absence of delirium Score 4: + delirium Identify patients who may benefit from antipsychotics Minimize unnecessary treatmentIntensive Care Delirium Screening ChecklistCommon Sedatives Used in the ICUM echanism of ActionDosingPharmacokineticsAdverse EffectsPropofolGABA+NMDA-Bolus: Relative Max: 100 mgInfusion: 5-50 mcg/kg/minMax: 75 mcg/kg/minOnset: < 1 minuteDuration: < 10 minutesMay be slightly increased with prolonged infusionsMetabolism:HepaticRisk for Accumulation: MinimalHypotension Bradycardia Respiratory SuppressionHypertriglyceridemia PropofolInfusion Syndrome (PRIS) Green Urine (Benign) Caloric Contribution ( kcal/mL)Soy/Egg AllergyDexmedetomidineCentral 2 AgonistLoading Dose: Not Recommended1 mcg/kg over 10minInfusion: mcg/kg/hourRelative Max: mcg/kg/hourOnset(withoutLoading Dose):20-30 minutesDuration: 30-60 minutesMetabolism:HepaticRisk for Accumulation: MinimalBradycardia Hypotension No Respiratory SuppressionWithdrawal following Prolonged Use (Role for Clonidine) Rare: Fever, HPA Suppression, Electrolyte AbnormalitiesMidazolamGABA+Bolus: 2-4mgInfusion: 1-10 mg/hrConsider Bolus with Initiation and Dose IncreasesOnset(Bolus): 2-5 minutesDuration(singledose):1.
Fentanyl •Pharmacologic Class: Opioid Analgesic •Mechanism of Action: •Binds to opioid receptors throughout CNS, increasing pain threshold and altering pain signal reception •Action in the CNS respiratory center directly suppresses respiratory drive •Dosing •Bolus: 50-100 mcg •Infusion: 25-200 mcg/hr
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