Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2005
Review Case ReportsToward solving the sedation-assessment conundrum: bi-spectral index monitoring and sedation interruption.
The sedation-assessment conundrum is defined by two diametrically opposed goals: to maintain an appropriate level of sedation, and to obtain a comprehensive neurologic examination that most accurately reflects the patient's neurologic status. A case presentation leads to a discussion of over-sedation and under-sedation issues that impact the care of critically ill patients. This information is useful in understanding the many methods of assessing sedation and interpreting individualized patient responses to sedation. The use of bi-spectral index monitoring and periods of sedation interruption are discussed within the context of addressing the sedation-assessment conundrum.
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The stay in an ICU is a complex mixture of providing optimal care while keeping the patient safe. Means of reducing the anxiety associated with the ICU stay include frequent reorientation and maintenance of patient comfort with sedation supplemented by analgesia as needed. ⋯ A common complication of sedation is tolerance, which can lead to withdrawal if the sedation is discontinued hastily. This article evaluates the occurrence of tolerance and withdrawal in the most commonly used sedatives in critically ill patients.
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Crit Care Nurs Clin North Am · Sep 2005
ReviewSleep and sedation in the pediatric intensive care unit.
Sleep is an important and necessary function of the human body. Somatic growth and cellular repair occur during sleep. ⋯ Medications administered in the pediatric intensive care unit can also disrupt sleep. This article reviews what is known about sleep in the pediatric intensive care unit and the effects of common sedation medications on sleep.
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Crit Care Nurs Clin North Am · Sep 2005
ReviewObstructive sleep apnea and modifications in sedation.
Obstructive sleep apnea is a common problem affecting all ages, particularly in conjunction with other pre-existing conditions. Compounding the disorder with the added insult of surgery, anesthesia, analgesia, and sedation requires the medical team continuously to re-evaluate this particular patient population. Physicians and nurses have recognized an increase in morbidity and mortality in patients with obstructive sleep apnea when they are administered anesthesia in conjunction with sedation. There are few reports of sedation alone and obstructive sleep apnea; most studies have been in relation to anesthesia, surgery, patient-controlled analgesia, and sleep-disordered breathing.