[Analgesia, sedation and anaesthesia in emergency service]

Skilful analgesia is self-explanatory and needs no justification. In contrast to this, preclinical general anaesthesia is of relative value and depends, in part, on the professional qualities of the emergency physician. Analgesic and anaesthestic drugs should be administered via a safe intravenous line. In contrast to rapid sequence induction of general anaesthesia, analgesic drugs should be titrated. The patient has to be monitored by the vigilance of the physician and adequate technical equipment. Metamizol is used for treatment of minor and medium pain, while morphine is indicated for treatment of major pain, especially in internal patients. Fentanyl is mainly used for total intravenous anaesthesia with controlled ventilation. (S)-ketamine is indicated for analgesia, analgosedation and anaesthesia in trauma patients, except isolated or dominating craniocerebral trauma, and in special internal cases. Midazolam is used for sedation or, in combination with (S)-ketamine or fentanyl, total intravenous anaesthesia. Etomidate is especially useful for induction of emergency patients with sufficient cardiovascular stability. Suxamethonium is the standard relaxant for endotracheal intubation during rapid sequence induction. If longer muscle relaxation is necessary, vecuronium should be used due to its simple storage and general lack of untoward effects. Butylscopolamin is used in colic pain, either alone or in combination with analgesic drugs. Haloperidol is indicated in acute psychotic syndromes as well as psychomotoric and alcohol-dependent excitation. On the whole, profound pharmacological and practical knowledge is necessary, although restricting oneself to just a few drugs increases the depth of one's personal experience.