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Related Concept Videos

Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
Sedatives and Hypnotics Drugs: Barbiturates01:20

Sedatives and Hypnotics Drugs: Barbiturates

Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A key...
Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

Sedatives and Hypnotics Drugs: Miscellaneous Agents

Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
CNS Depressants: Barbiturates and Benzodiazepines01:14

CNS Depressants: Barbiturates and Benzodiazepines

CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...

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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
07:54

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Published on: December 6, 2016

Sedation in the ICU.

Thomas Strøm1

  • 1Department of Anaesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. t.s@dadlnet.dk

Danish Medical Journal
|May 3, 2012
PubMed
Summary
This summary is machine-generated.

A no sedation strategy for mechanically ventilated patients significantly reduced ventilation time, intensive care unit (ICU) stay, and hospital length of stay. This approach also lowered the risk of acute kidney injury without increasing long-term psychological issues.

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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
06:04

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

Published on: July 4, 2018

Area of Science:

  • Critical Care Medicine
  • Intensive Care Unit Management
  • Mechanical Ventilation Strategies

Background:

  • Continuous sedation is the standard for critically ill patients on mechanical ventilation.
  • A 'no-sedation' approach has been explored, potentially reducing ventilation time and complications like acute renal failure.
  • The efficacy and safety of 'no-sedation' have not been rigorously tested in prospective randomized trials.

Purpose of the Study:

  • To evaluate if a no-sedation strategy reduces mechanical ventilation duration, intensive care unit (ICU) length of stay, and total hospital stay.
  • To determine if a no-sedation strategy decreases secondary organ failure, specifically kidney injury.
  • To assess if a no-sedation strategy increases the risk of long-term psychological problems, such as post-traumatic stress disorder (PTSD).

Main Methods:

  • A randomized trial involving 140 critically ill patients requiring mechanical ventilation.
  • Intervention group received minimal sedation (only if delirium suspected) with bolus morphine or haloperidol.
  • Control group received standard continuous sedation infusions, with daily interruptions. Kidney function and psychological outcomes (PTSD, depression) were assessed post-discharge.

Main Results:

  • The no-sedation group experienced 4.2 more days without mechanical ventilation (P=0.0191).
  • ICU length of stay decreased by 9.7 days (P=0.0316) and total hospital stay by 24 days (P=0.0039) in the no-sedation group.
  • The no-sedation group showed improved urine output (P=0.03) and reduced renal impairment (51% vs. 76%, P=0.012) compared to the sedation group. No significant differences in long-term psychological health were observed.

Conclusions:

  • A no-sedation strategy for mechanically ventilated patients leads to significantly fewer days on ventilation and shorter ICU and hospital stays.
  • This strategy appears to reduce the risk of acute kidney injury.
  • The no-sedation approach does not negatively impact long-term psychological outcomes.