Asynchrony with the ventilator (“bucking the vent”) is a common indication for starting treatment with sedative, analgesic, and neuromuscular blocking agents.
These agents depress respiratory effort to reduce patients’ discomfort and facilitate oxygenation, particularly when complex ventilatory modes are being used.
Shahriar Alikhani, MD Attending Anesthesiologist, Mission Hospital Regional Medical Center and Children's Hospital of Orange County Shahriar Alikhani, MD is a member of the following medical societies: American Society of Anesthesiologists, International Anesthesia Research Society, Phi Beta Kappa, Society for Pediatric Anesthesia Disclosure: Nothing to disclose.
Q: When are sedative, analgesic, or neuromuscular blocking agents indicated in critically ill patients with respiratory disease?
It may be used as a carrier gas with oxygen in combination with more potent general inhalational gases for surgical anesthesia.
Ally N Alai, MD, FAAD Medical Director, The Skin Center at Laguna; Former Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine, School of Medicine; Former Professor and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Expert Medical Reviewer, Medical Board of California; Expert Consultant, California Department of Consumer Affairs; Expert Reviewer, California Department of Registered Nursing Ally N Alai, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Society for MOHS Surgery Disclosure: Nothing to disclose.
Ghada Aluzri, MD President, West Coast Anesthesia; Anesthesiologist, Pacific Hills Surgical Center, Huntington Reproductive Center Ghada Aluzri, MD is a member of the following medical societies: American Society of Anesthesiologists Disclosure: Nothing to disclose.However, many patients who require mechanical ventilation need short-term sedation and/or analgesia for reasons that are less obvious in noncommunicating patients than in patients who can communicate: to relieve anxiety produced by the intensive care unit (ICU) environment, underlying illness, or invasive diagnostic or therapeutic procedures (eg, presence of an endotracheal tube, tracheal suctioning).It is well known that inadequate control of pain or anxiety can stimulate various stress responses, resulting in tachycardia, increased myocardial oxygen consumption, reduced lung volumes, immuno-suppression, hypercoagulability, and, ultimately, increased morbidity and mortality.O), commonly known as laughing gas or happy gas, was first discovered in 1793 by the English scientist Joseph Priestly and has been used for more than 150 years.It has remained one of the most widely used anesthetics in both dental and medical applications.Heightened awareness of the level of anxiety and pain experienced by critically ill patients, and of the inadequacy of currently used treatment strategies, has stimulated debate about the optimal method for sedating patients who require mechanical ventilation.In order to be most effective, treatment should be selected primarily on the basis of the patient’s signs and symptoms, the presence of underlying disease, and the patient’s medication history.Pertinent clinical information on sedatives, analgesics, and neuromuscular blockers frequently used in the ICU are summarized in Tables 1.Cost is an additional factor to be considered when selecting drugs to be routinely used in the ICU.Intermittent intravenous administration may be a useful option, allowing clearance of the drug and reassessment of mental status before redosing.Lorazepam or propofol may be appealing options for this purpose, because both drugs undergo conjugation, a pathway generally spared until severe hepatic dysfunction occurs.