CONCEPTS OF ANALGESIA AND SEDATION - FENT ANYL AND DEHYDROBENZPERIDOLIN CRITICALLY ILL INTENSIVE-CARE PATIENTS ON LONG-TERM VENTILATION

The consequent use of analgetics and sedatives in intensive care patie nts should be a firmly integrated component of the treatment concept. A precondition for successful sedation of a ventilated patient is free dom from pain, which should also be guaranteed during the weaning phas e. For analgesia/sedation, the combination of fentanyl and DHBP is rec ommended. The use of DHBP during prolonged administration of fentanyl not only reduces the possibility of cholestasis and prevents opioid-re lated nausea, but also has a favourable influence on the autonomic ner vous system and produces a good combination of psychic distance and se dation. Further desirable effects of DHBP are augmentation of analgesi a and reduction of the addictive potential of fentanyl. The duration o f fentanyl-DHBP use is not limited, so that lengthy administration is possible. The patients are readily aroused and responsive, thus permit ting neurological evaluation. Weaning from the respirator with good co operation on the part of the patient is also possible. Fentanyl-DHBP i s administered via an injection pump at a ratio of 1 mg fentanyl:12.5 mg DHBP. In very critically ill patients (e.g. sepsis), sedation with fentanyl-DHBP is not sufficient. In these cases, addition of flunitraz epam, where necessary by continuous infusion is recommended. To avoid withdrawal symptoms after long-term sedation, the daily dose should be tapered by no more than 20 % per day.