Disadvantages of sedating neurologic patient moeny dating
Whether a strategy of avoiding sedation is applicable to neurointensive care is unknown: this must be balanced between the potential benefit that daily interruption of sedation might have on enhancing awakening and monitoring of neurological function and the risk that stopping sedatives (hypnotics) and analgesics (opioids) might exacerbate intracranial hypertension in patients with reduced brain compliance.
In addition, ABI patients were generally excluded from randomized trials on sedation, and therefore the level of evidence to guide sedative choice or algorithms for sedation–analgesia management is generally low .
These negative effects can be largely prevented if MAP is maintained.
Systemic haemodynamic effects are usually dose dependent; therefore, to minimize the risk of hypotension and reduced CPP, it is important to carefully assess preload and ensure normovolemia in all patients, particularly in those with pre-existing heart disease.
Titration and withdrawal of sedation in the NICU setting has to be balanced between the risk that interrupting sedation might exacerbate brain injury (e.g.
Beyond this level, no further suppression of cerebral oxygen consumption can occur, while minimal consumption persists for cellular homeostasis , although CBF reductions with benzodiazepines tend to be more variable than those with propofol, probably because benzodiazepines do not easily produce burst suppression or an isoelectric EEG.Sedation also is an essential therapeutic component of intracranial pressure therapy, targeted temperature management and seizure control.Given the lack of large trials which have evaluated clinically relevant endpoints, sedative selection depends on the effect of each agent on cerebral and systemic haemodynamics.It is now well established, based on randomized trials conducted in the general ICU adult and paediatric populations, that minimizing or avoiding sedation provides a better outcome, including shorter duration of mechanical ventilation and length of hospital stay .Less sedation also facilitates early mobilization, reduces the need for additional examinations such as cerebral computed tomography scan or electroencephalography (EEG) to assess brain function, and might reduce delirium and healthcare costs .