ANALGOSEDATION IN PATIENTS WITH SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

Aims and pathophysiology: Intensive care patients are exposed to a num ber of noxious stimuli, They require individual analgesia and sedation to reduce and moderate the stress response to endogenous and exogenou s stressors. In patients with SIRS (systemic inflammatory response syn drome), pathophysiological conditions with multiple organ dysfunction or failure demand special efforts and a specific regimen of analgoseda tion. The main goals are the absence of cardiocirculatory depression o r, if at all possible, cardiocirculatory stabilization, absence of neg ative pulmonary, renal, hepatic and immunological side effects, preser vation of a moderate stress response, and vertical and horizontal cont rol appropriate to the clinical situation. Characterization of analget ics and sedatives. Amongst the analgesic drugs, opioids and morphine h ave moderate cardiocirculatory side effects, but reduce the intestinal motility. Due to intrinsic sympathomimetic activity, ketamine has sta bilizing cardiocirculatory effects, reduces the exogenous catecholamin e requirement and has no negative gastrointestinal side effects. Among st the sedative drugs, midazolam has only moderate cardiocirculatory s ide effects. Propofol has cardiovascular depressant properties, but ho rizontal control of propofol sedation is excellent. Conclusion. The ph armacological profile of analgesic and sedative components suggests, t hat the combination of ketamine and midazolam can be recommended for a nalgosedation of patients with SIRS. This is supported by several clin ical investigations. In specific situations, that require excellent ve rtical control, the combination of ketamine and propofol should be pre ferred.