Chapter

Neurologic Manifestations of Muscle Relaxants and Drugs Used for Analgesia and Anesthesia in the Intensive Care Unit

Eelco F. M. Wijdicks

in Neurologic Complications of Critical Illness

Published on behalf of © Mayo Foundation for Medical Education and Research

Published in print May 2009 | ISBN: 9780195371093
Published online April 2013 | e-ISBN: 9780199322886 | DOI: http://dx.doi.org/10.1093/med/9780195371093.003.0002

Series: Contemporary Neurology Series

Neurologic Manifestations of Muscle Relaxants and Drugs Used for Analgesia and Anesthesia in the Intensive Care Unit

Show Summary Details

Preview

Critically ill patients are sedated to facilitate mechanical ventilation, overcome anxiety, protect against myocardial stress and ischemia, and support sleep. The desired depth may vary from “conscious sedation,” which creates a comfort level to allow nursing procedures without pain, to levels approaching general anesthesia. Many agents (e.g., midazolam and propofol) are administered by continuous infusion. Neurologic assessment in sedated patients is unmistakably less accurate, but with knowledge of the pharmacokinetics and pharmacodynamics of each agent, some reasonable estimate of its effect is possible. In the ideal situation, sedation is simply briefly discontinued or pharmacologically reversed, but the severity of illness can dictate prolonged use, and suggesting termination of sedation may be inappropriate. Medical and surgical ICUs often have implemented a sedation–analgesia protocol that results in a calm and comfortable patient.1,2 Sedation aside, many analgesic drugs are used in the ICU, predominantly in surgical ICUs. Neuromuscular blocking agents have been used frequently for brief procedures, but when administered for prolonged periods of time, their utility has been questioned. This chapter summarizes commonly used muscular relaxants, anesthetic, and analgesic drugs in critical illness and also addressed the interaction of drugs.

Chapter.  8271 words.  Illustrated.

Subjects: Neurology

Full text: subscription required

How to subscribe Recommend to my Librarian

Buy this work at Oxford University Press »

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.