Use of sedative and analgesic agents in neurotrauma patients: Effects on cerebral physiology

Sedation and analgesia is used primarily in the intensive care unit (ICU) t o limit the stress response to critical illness, provide anxiolysis, improv e ventilatory support, and facilitate adequate ICU care. However, in the ne urotrauma ICU there are many other reasons for the use of these agents. The primary aim is to prevent secondary cerebral damage by maintaining adequat e cerebral perfusion pressures. This is accomplished in several different w ays. Controlling intracranial pressure (ICP) and maintaining an adequate me an arterial pressure (MAP) is at the cornerstone of this management. Loweri ng the metabolic demands of the brain is also an important consideration as a treatment strategy. Analgesic and sedative agents are utilized to preven t undesirable increases in ICP and to lower cerebral metabolic demands. Con cerns surrounding the use of these agents include time to awakening after d iscontinuation, effect on the cerebrovasculature, and the effect on patient outcome. There are many different pharmacological agents available, each w ith their distinct advantages and disadvantages. The purpose of this review is to evaluate the pharmacokinetic and pharmacological effects of each oi these agents when used in neurotrauma patients.