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miércoles, 12 de octubre de 2016

Post-Intubation Analgesia/Sedation

emDocs - October 11, 2016 - Authors: Birnbaum K and Willis J
Edited by: Cassella C and Koyfman A
Intubation is an important intervention in the ED. We see a critical or impending airway problem and we secure the airway with intubation–very satisfying! Yet our job does not stop there. In addition to maintaining an appropriate ventilation strategy after intubation, it is crucial that we use appropriate post-intubation sedation and analgesia regimens for the continued care of these critical patients. This post will review sedation and analgesia regimens for different clinical scenarios after intubation, as well as some common pitfalls that we must be diligent to avoid...
Conclusion / Take-Home Points
  • Don’t forget about post-intubation sedation/analgesia. Order these medications with your RSI meds and communicate with your nurses.
  • Mechanical ventilation hurts and pain control is always primary. Every intubated patient should have adequate analgesia. An objective scale like RASS should be used to assess additional sedation needs after primary analgesia is started.
  • Nonbenzodiazepines like ketamine, propofol, and dexmedetomidine are first-line recommendations for sedation over benzodiazepines and are associated with better outcomes.
  • Consider the hemodynamic profile when choosing medications and don’t neglect analgesia/sedation out of fear for hypotension. Use ketamine for sedation and analgesia in patients with persistent hypotension. Use propofol for hypertensive patients and primary neurological problems (seizures, delirium tremens, hemorrhagic stroke, head trauma)."