ABSTRACT
Sedation and analgesia constitute one of the cornerstones in the management of the critically ill patients. Most patients admitted to an Intensive Care Unit require prolonged sedation and analgesia. It has been demonstrated that adequate sedo- analgesia lessens stress-related events in the critically ill patients, facilitating their management and improving their outcomes. However, the use of sedatives and analgesics, especially when administered in continuous intravenous infusion, may have its complications derived from its infra or over utilization with proved impact on the outcome of critically ill patients. A proper monitoring and the implementation of sedation and analgesia protocols warrant the adequate management of existing sedatives aiding to avoid tolerance and dependency events. Strategies such as "sequential sedation", "dynamic sedation" or "daily sedation interruption" have been proposed as efficacious tools for the avoidance of complications related to prolonged sedation. In the present chapter, concepts related to prolonged sedation (meaning sedation for more than 72 hours) are reviewed; available agents are evaluated and strategies aimed to assure quality in its application are described.
Subject(s)
Deep Sedation/methods , Intensive Care Units/statistics & numerical data , Humans , Time FactorsABSTRACT
La sedoanalgesia es uno de los pilares básicos del manejo del paciente crítico. La mayoría de los pacientes ingresados en una Unidad de Cuidados Intensivos requiere sedoanalgesia de forma prolongada. Una adecuada sedoanalgesia disminuye el grado de estrés del paciente crítico, facilitando su manejo y tratamiento y mejorando su pronóstico. Sin embargo, la sedoanalgesia, sobre todo en perfusión continua, es una práctica que no está exenta de complicaciones derivadas tanto de su infra-como de su sobre-utilización, que pueden empeorar el pronóstico de los pacientes críticos. Una adecuada monitorización y la aplicación de protocolos consensuados en sedoanalgesia garantizan la utilización adecuada de los sedantes evitando fenómenos de tolerancia y dependencia. Estrategias como la sedación secuencial, la sedación dinámica o la interrupción diaria de la sedación se han propuesto como herramientas útiles para evitar complicaciones asociadas a la sedación prolongada. En el presente capítulo se revisan conceptos relacionados con la sedación prolongada, entendida ésta como aquélla cuya duración es mayor de 72 horas; se evalúan los agentes disponibles y se proponen estrategias para garantizar la calidad de su aplicación (AU)
Sedation and analgesia constitute one of the cornerstones in the management of the critically ill patients. Most patients admitted to an Intensive Care Unit require prolonged sedation and analgesia. It has been demonstrated that adequate sedo-analgesia lessens stress-related events in the critically ill patients, facilitating their management and improving their outcomes. However, the use of sedatives and analgesics, especially when administered in continuous intravenous infusion, may have its complications derived from its infra or over utilization with proved impact on the outcome of critically ill patients. A proper monitoring and the implementation of sedation and analgesia protocols warrant the adequate management of existing sedatives aiding to avoid tolerance and dependency events. Strategies such as sequential sedation, dynamic sedation or daily sedation interruption have been proposed as efficacious tools for the avoidance of complications related to prolonged sedation. In the present chapter, concepts related to prolonged sedation (meaning sedation for more than 72 hours) are reviewed; available agents are evaluated and strategies aimed to assure quality in its application are described (AU)
Subject(s)
Female , Humans , Male , Conscious Sedation/instrumentation , Conscious Sedation/methods , Critical Care/methods , Critical Care , Pharmaceutical Preparations/administration & dosage , Pharmaceutical Preparations/metabolism , Drug Tolerance/genetics , Clinical Protocols/classification , Conscious Sedation/classification , Conscious Sedation , Critical Care/ethics , Critical Care , Pharmaceutical Preparations , Pharmaceutical Preparations/supply & distribution , Drug Tolerance/physiology , Clinical Protocols/standardsSubject(s)
Antiemetics/adverse effects , Heart Block/chemically induced , Metoclopramide/adverse effects , Aged , Antiemetics/administration & dosage , Electrocardiography , Heart Block/diagnosis , Heart Block/therapy , Humans , Injections, Intravenous , Male , Metoclopramide/administration & dosage , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Male , Aged , Humans , Endocardial Cushion Defects/chemically induced , Heart Block/chemically induced , Metoclopramide/adverse effects , Postoperative ComplicationsABSTRACT
Las causas de bajo nivel de conciencia tras el postoperatorio de cirugía cardíaca son numerosas. Una de ellas muy poco frecuente es el infarto o hemorragia de un adenoma hipofisario que, en general, no había sido diagnosticado previamente. Describimos el caso de una paciente que, durante el postoperatorio de cirugía cardíaca, presentó una evolución tórpida con múltiples complicaciones, entre ellas bajo nivel de conciencia, siendo diagnosticada de macroadenoma hipofisario e hipopituitarismo, y con un curso evolutivo favorable mediante tratamiento hormonal sustitutivo (AU)