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
ReviewAlcohol withdrawal syndrome: assessment and treatment with the use of the Clinical Institute Withdrawal Assessment for Alcohol-revised.
Alcoholism is a chronic, complex disease and addictive disorder. Sudden cessation of alcohol consumption can lead to alcohol withdrawal, an acute process with devastating and potentially life-threatening consequences. ⋯ The higher the patient's score, the greater the risk for experiencing serious withdrawal symptoms. Pharmacotherapy may be gauged to treat the symptoms according the score.
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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.