[Sedative-analgesic medication in intensive care patients needing ventilator treatment]

It was the aim of this study to compare two regimens for sedation and analgesia during ventilator treatment in intensive care patients. Special regard was given to endocrine stress response, neuro-monitoring, hemodynamic parameters and clinical practicability.

A total number of 16 patients of an operative ICU were randomly allocated to the following groups: (1) Fentanyl-group, approximately 0.2 mg/h fentanyl, 2.5 mg/h midazolam and 2 mg/h pancuronium in intermittent doses, (2) ketamine-group, about 50 mg/h ketamine and 2.5 mg/h midazolam by syringe pump, in addition 2 mg/h pancuronium. During a period of 2 days and in intervalls of 6 h, plasma levels of epinephrine and norepinephrine (by HPLC/ECD), ADH, ACTH and cortisol (by RIA), ketamine (by GC) and stress-metabolites (glucose, lactate, free glycerol) were determined. Hemodynamic parameters were investigated in intervalls of 12 h, EEG (Compressed Spectral Array, CSA) in intervalls of 24 h. In addition, routine laboratory data, vigilance and adaptation to the respirator were observed.

Plasma levels of adrenaline, noradrenaline, dopamine, ADH, ACTH, cortisol and stress-metabolites were comparable in both groups. Levels of ADH, ACTH, cortisol and free glycerol did not leave the normal range. In three patients, in which epinephrine- or norepinephrine-infusions were necessary to improve cardiocirculatory stability, this treatment could be finished after beginning of the ketamine application. In both groups, CSA showed a dominant delta- und theta-activity according to the clinical aspects of sufficient sedation and analgesia. Hemodynamic parameters were comparable in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)