Sedative Agents and Neuromuscular Blockade PDF

Sedative Agents Anxiety in the critical care setting is typically treated with benzodiazepines, propofol, or dexmedetomidine Both pain and anxiety may exist with evidence of psychotic features (as manifested in delirium). In this situation, neuroleptic agents, antidepressants, and anesthetic...

Sedative Agents Anxiety in the critical care setting is typically treated with benzodiazepines, propofol, or dexmedetomidine Both pain and anxiety may exist with evidence of psychotic features (as manifested in delirium). In this situation, neuroleptic agents, antidepressants, and anesthetic agents are administered.  Benzodiazepines are sedatives and hypnotics They are not analgesics Elderly renal or hepatic insufficiency patients may exhibit slower clearance of benzodiazepines, contributing to a significant delay in elimination. Patients receiving continuous infusions must be monitored for the effects of over-sedation.  Propofol is an intravenous general anesthetic(high doses). Sedative and hypnotic Propofol has no analgesic properties hemodynamically unstable patients may become hypotensive with the initiation of sedation It has a rapid onset and short duration of sedation. Adverse effects include hypotension, bradycardia it should be counted as a caloric source high-dose infusions may result in high triglyceride levels, metabolic acidosis, or dysrhythmias. Propofol requires a special access for continuous infusion ( infection & incompatibility). Maximum hanging time 12 hours. Neuromuscular Blockade (NMB) NMB agents do not possess any sedative or analgesic properties. It induce muscles relaxation Muscle relaxants are used in critically ill patients to facilitate endotracheal intubation and mechanical ventilation, to control increases in intracranial pressure (ICP), and to facilitate procedures at the bedside (e.g., bronchoscopy, tracheostomy). Patients on neuromuscular blockade: Not able to muscle voluntary communicate or to produce movement, any and breathing. Therefore any patient receiving these agents must also be sedated. Many institutions start continuous infusions of sedative medications before they administer an NMB agent. If a patient experiences pain or anxiety while receiving an NMB agent, an increase in heart rate or blood pressure may be noted  Assessing the level or degree of paralysis by using a train of four peripheral nerve stimulator to determine a train-of-four (TOF) response. The TOF evaluates the level of neuromuscular blockade to ensure that the greatest effect is achieved with the lowest dose of NMB.