[Analgesia and sedation on patients with sepsis syndrome]

AIMS AND PATHOPHYSIOLOGY: Intensive care patients are exposed to a number of noxious stimuli. They require individual analgesia and sedation to reduce and moderate the stress response to endogenous and exogenous stressors. In patients with SIRS (systemic inflammatory response syndrome), pathophysiological conditions with multiple organ dysfunction or failure demand special efforts and a specific regimen of analgosedation. The main goals are the absence of cardiocirculatory depression or, if at all possible, cardiocirculatory stabilization, absence of negative pulmonary, renal, hepatic and immunological side effects, preservation of a moderate stress response, and vertical and horizontal control appropriate to the clinical situation.

Amongst the analgesic drugs, opioids and morphine have moderate cardiocirculatory side effects, but reduce the intestinal motility. Due to intrinsic sympathomimetic activity, ketamine has stabilizing cardiocirculatory effects, reduces the exogenous catecholamine requirement and has no negative gastrointestinal side effects. Amongst the sedative drugs, midazolam has only moderate cardiocirculatory side effects. Propofol has cardiovascular depressant properties, but horizontal control of propofol sedation is excellent.

The pharmacological profile of analgesic and sedative components suggests, that the combination of ketamine and midazolam can be recommended for analgosedation of patients with SIRS. This is supported by several clinical investigations. In specific situations, that require excellent vertical control, the combination of ketamine and propofol should be preferred.