Analgesia, sedation and neuromuscular blockade in mechanically ventilated cardiac intensive care unit patients. Part II--sedation.
This article reviews relevant clinical issues regarding sedation, analgesia and neuromuscular blockade in the cardiac intensive care unit, including monitoring tools and available therapeutic options. The pathophysiologic implications of pain, agitation, anxiety and delirium in the ventilated patient are also discussed. Although guidelines for sedation, analgesia and neuromuscular blocking drugs in critical care have recently been published, there is great variability in clinical practice. The complexity of the environment and associated pathologies makes it difficult to implement universally applicable therapeutic regimens. Knowledge of pharmacologic mechanisms is an important tool in the development of dynamic protocols adapted to each unit. Strategies that include monitoring resources are essential for the optimization of sedation, analgesia and neuromuscular blockade.
Vilela
Hugo
H
Serviço de Cardiologia, Hospital Fernando Fonseca, Amadora, Portugal.
Ferreira
Daniel
D