Post-intubation
sedation
www.propofology.com
@Gas_Craic
#smaccDUB
Sedation doesn’t blunt pain - most are not analgesics.
Sedation without analgesia = delirium
Delirium = associated with death
Early sedation strategy has a lasting effect on the course of their stay
Deep sedation in the first 48h was associated with death.
PTSD is more associated with deeper sedation than too light.
The patient should ideally be orientated, asleep & safe
'A1' Sedation = Analgesia First - allows you to work out what pain they actually have.
Control Pain and tube intolerance etc with analgesia and come down off sedation.
Use a pain scale with nursing care - once pain controlled then use some sedation.
Benzodiazepines usually avoided - increased assoc. with delirium - difficult to titrate.
Propofol = Good sedation and wears off quickly
Dexmedetomidine = preserved sleep architecture, never bolus - takes a while to work.
Pain cannot and should not be a pressor/inotrope!!
Try Ketamine for the unstable - 1mg/kg dissociative bolus for induction, then infusion
eCASH - 2016 - early comfort analgesia, minimal sedation, maximal humane care. (click here)
Beware muscle relaxants! They may lie still for you,
but you can be doing real psychological and physiological harm.
@emcrit
MAIN ISSUES
AGRESSIVE ANALGESIA, GENTLE SEDATION
