PRINCIPLES OF SEDATION AND ANALGESIA IN C RITICALLY ILL PATIENTS

This lecture outlines the current pharmacological concepts of sedation and analgesia in the critically ill patient requiring intensive care therapy. The primary goal is to sedate such patients so that they tole rate mechanical ventilation, as well as the therapeutic and diagnostic procedures that are routinely performed on an intensive care ward. Th e pharmacological regimen comprises both anxiolytic and analgesic drug s. So far, no drug combination has been identified as the ideal therap y; the standard deviation of successful analgosedation is large due to an unpredictable individual response. Because the drugs currently use d are free of toxic side effects, the selection made is mainly determi ned by factors relating to pharmacokinetic criteria, such as short hal f-life of action or a predictable time of elimination. So far, the sel ection or combination of certain drugs has not been found to influence the patient's outcome in severe disease states such as sepsis, multip le trauma, or neurotrauma. ''Good quality'' of sedation and analgesia is still judged by its ability to suppress tachycardia, hypertension, hyperventilation or respiratory efforts against mechanical ventilation and the absence of increases in intracranial pressure during therapeu tic manoeuvres.