Critical care clinics
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Critical care clinics · Oct 1995
ReviewUse of neuromuscular blocking drugs in the critically ill patient.
Neuromuscular blocking drugs are used routinely to facilitate the care of critically ill patients of all ages. This article addresses current uses and concerns about the appropriate administration of these drugs. Several important topics are highlighted, including basic physiology of neuromuscular transmission, blocker pharmacology, drug selection, monitoring, and future areas of research.
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Sedative drugs commonly are titrated to effect in critically ill patients. Subjective clinical assessment tools are used to determine the patient's level of sedation, and there clearly is a need for improved quantitative methods of monitoring sedation. This article describes the current methods for assessing the level of sedation in critically ill patients and discusses the potential role of neurophysiologic monitoring using processed electroencephalograms and evoked potentials.
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Critical care clinics · Oct 1995
ReviewThe cost of sedating and paralyzing the critically ill patient.
The cost of health care is consuming an ever-increasing amount of United State's gross domestic product. It is estimated that 15% of health care dollars are spent in the ICU. ⋯ Many of the sedatives, analgesics, and neuromuscular blocking agents have high acquisition and indirect costs. Educating ICU practitioners on cost issues and key indications for these drugs not only may help with cost containment in the ICU but also can improve patient care.
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Critical care clinics · Oct 1995
ReviewComplications associated with sedative and neuromuscular blocking drugs in critically ill patients.
Pharmacologic administration of sedatives is used routinely in the care of the critically ill to enhance patient comfort and optimize care. Long-term administration of NMB drugs is far less frequent but often occurs in patients with greater organ dysfunction. The experience of several authors using NMB drugs in the ICU is summarized in Table 5. ⋯ Pathophysiologic changes in the nerve, muscle, or neuromuscular junction may also play a role in the development of some cases of prolonged weakness or myopathy after discontinuation of NMB drugs. Concerns about the potential for direct or indirect toxicity of NMB drugs to skeletal muscle and in the CNS remain. Resolution of these issues will improve the selection and optimal administration of sedative and NMB drugs in the ICU setting.
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Critical care clinics · Oct 1995
ReviewSedation of the agitated, critically ill patient without an artificial airway.
One of the most demanding and stressful situations is management of the agitated, unintubated, critically ill patient. Sedation often must be provided without a specific diagnosis, and the need for rapid airway control must be anticipated. No predictably safe and effective techniques are proven. ⋯ Prolonged need for significant sedative medication usually mandates a secure airway. Once this is accomplished, the requirement for a continuously present airway expert at the bedside is removed. The standard for sedating a patient without an artificial airway requires a higher level of expertise than sedating a critically ill patient with an artificial airway.