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Chapter 5 - Analgesia, Sedation, and Paralysis in the Neurocritical Care Unit

Published online by Cambridge University Press:  24 July 2019

By
Yousef Hannawi  and
Wendy C. Ziai
Edited by
Michel T. Torbey
Michel T. Torbey
Affiliation:
Ohio State University
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Summary

An intensive care unit (ICU) stay is often a stressful and painful experience. Recent surveys indicate that 50–80% of patients experience pain during their ICU stay [1]. Critically ill patients experience pain more readily than healthy subjects; a phenomenon known as hypernociception. The most painful experiences for ICU patients are endotracheal suctioning and being turned in bed. In addition, many patients have pain at rest without a noxious stimulus [1]. This decreased threshold of pain in the ICU has been attributed to immobility and systemic inflammation. In addition to pain, ICU patients often suffer from stress, which has been frequently attributed to painful procedures. Other factors that may play a role in ICU stress include inability to communicate due to endotracheal intubation, interruption of sleep, hallucinations, and nightmares. This stressful experience is not without complications, as one retrospective study found that 25% of ICU patients with self-reported stressful experiences during their ICU stay, such as nightmares, anxiety, respiratory distress, or pain, showed symptoms of post-traumatic stress disorder four years later [2], thus, the importance of adequate analgesia and sedation to achieve patient comfort.

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Chapter
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Neurocritical Care , pp. 33 - 49
Publisher: Cambridge University Press
Print publication year: 2019

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References

Marino, PL (2014). Analgesia and sedation in the ICU. In The ICU Book 4th edn. Philadelphia, PA: Walters Kluwer Health/Lippincott Williams & Wilkins, 901–922.Google Scholar
Schelling, G, Stoll, C, Haller, M, et al. (1998). Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26(4): 651–659.Google Scholar
Kress, JP, Pohlman, AS, O’Connor, MF, Hall, JB. (2000). Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342(20): 1471–1477.Google Scholar
Pandharipande, PP, Girard, TD, Jackson, JC, et al. (2013). Long-term cognitive impairment after critical illness. N Engl J Med 369(14): 1306–1316.Google Scholar
Makii, JM, Mirski, MA, Lewin, JJ 3rd (2010). Sedation and analgesia in critically ill neurologic patients. J Pharm Pract 23(5): 455–469.CrossRefGoogle ScholarPubMed
Mirski, MA, Hemstreet, MK. (2007). Critical care sedation for neuroscience patients. J Neurol Sci 261(1–2): 16–34.Google Scholar
Barr, J, Fraser, GL, Puntillo, K, et al. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41(1): 263–306.Google Scholar
Jacobi, J, Fraser, GL, Coursin, DB, et al. (2002). Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30(1): 119–141.Google Scholar
Mirski, MA, LeDroux, SN, Lewin, JJ 3rd, et al. (2010). Validity and reliability of an intuitive conscious sedation scoring tool: the nursing instrument for the communication of sedation. Crit Care Med 38(8): 1674–1684.CrossRefGoogle ScholarPubMed
Hutchens, MP, Memtsoudis, S, Sadovnikoff, N (2006). Propofol for sedation in neuro-intensive care. Neurocrit Care 4(1): 54–62.CrossRefGoogle ScholarPubMed
Young, CC, Prielipp, RC (2001). Benzodiazepines in the intensive care unit. Crit Care Clin 17(4): 843–862.Google Scholar
Fraser, GL, Devlin, JW, Worby, CP, et al. (2013). Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials. Crit Care Med 41(9 Suppl 1): S30–38.CrossRefGoogle ScholarPubMed
Avripas, MB, Smythe, MA, Carr, A, et al. (2001). Development of an intensive care unit bedside sedation scale. Ann Pharmacother 35(2): 262–263.Google Scholar
Angelini, G, Ketzler, JT, Coursin, DB (2001). Use of propofol and other nonbenzodiazepine sedatives in the intensive care unit. Crit Care Clin 17(4): 863–880.Google Scholar
Kumar, MA, Urrutia, VC, Thomas, CE, Abou-Khaled, KJ, Schwartzman, RJ (2005). The syndrome of irreversible acidosis after prolonged propofol infusion. Neurocrit Care 3(3): 257–259.CrossRefGoogle ScholarPubMed
Zarovnaya, EL, Jobst, BC, Harris, BT (2007). Propofol-associated fatal myocardial failure and rhabdomyolysis in an adult with status epilepticus. Epilepsia 48(5): 1002–1006.Google Scholar
Mueller, SW, Preslaski, CR, Kiser, TH, et al. (2014). A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal. Crit Care Med 42(5): 1131–1139.CrossRefGoogle ScholarPubMed
Aryan, HE, Box, KW, Ibrahim, D, Desiraju, U, Ames, CP. (2006). Safety and efficacy of dexmedetomidine in neurosurgical patients. Brain Inj 20(8): 791–798.Google Scholar
RxList: The Internet Drug Index. www.rxlist.com (accessed October 2018).Google Scholar
Vinclair, M, Broux, C, Faure, P, et al. (2008). Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. Intensive Care Med 34(4): 714–719.Google Scholar
McPhee, LC, Badawi, O, Fraser, GL, et al. (2013). Single-dose etomidate is not associated with increased mortality in ICU patients with sepsis: analysis of a large electronic ICU database. Crit Care Med 41(3): 774–783.CrossRefGoogle Scholar
Warner, KJ, Cuschieri, J, Jurkovich, GJ, Bulger, EM (2009). Single-dose etomidate for rapid sequence intubation may impact outcome after severe injury. J Trauma 67(1): 45–50.Google Scholar
Rahimi, SY, Vender, JR, Macomson, SD, et al. (2006). Postoperative pain management after craniotomy: evaluation and cost analysis. Neurosurgery 59(4): 852–857; discussion 857.Google Scholar
Quiney, N, Cooper, R, Stoneham, M, Walters, F (1996). Pain after craniotomy. A time for reappraisal? Br J Neurosurg 10(3): 295–299.CrossRefGoogle ScholarPubMed
(1979). Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain 6(3): 249.Google Scholar
Aissaoui, Y, Zeggwagh, AA, Zekraoui, A, Abidi, K, Abouqal, R (2005). Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg 101(5): 1470–1476.Google Scholar
Gottschalk, A, Berkow, LC, Stevens, RD, et al. (2007). Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg 106(2): 210–216.Google Scholar
De Benedittis, G, Lorenzetti, A, Migliore, M, et al. (1996). Postoperative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery 38(3): 466–469; discussion 469–470.Google ScholarPubMed
Chiaretti, A, Genovese, O, Antonelli, A, et al. (2008). Patient-controlled analgesia with fentanil and midazolam in children with postoperative neurosurgical pain. Childs Nerv Syst 24(1): 119–124.CrossRefGoogle ScholarPubMed
Morad, A, Winters, B, Stevens, R, et al. (2012). The efficacy of intravenous patient-controlled analgesia after intracranial surgery of the posterior fossa: a prospective, randomized controlled trial. Anesth Analg 114(2): 416–423.Google Scholar
Morad, AH, Winters, BD, Yaster, M, et al. (2009). Efficacy of intravenous patient-controlled analgesia after supratentorial intracranial surgery: a prospective randomized controlled trial. Clinical article. J Neurosurg 111(2): 343–350.Google Scholar
Thibault, M, Girard, F, Moumdjian, R, et al. (2007). Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study. Can J Anaesth 54(7): 544–548.CrossRefGoogle ScholarPubMed
Kirchheiner, J, Schmidt, H, Tzvetkov, M, et al. (2007). Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to CYP2D6 duplication. Pharmacogenomics J 7(4): 257–265.Google Scholar
Sudheer, PS, Logan, SW, Terblanche, C, Ateleanu, B, Hall, JE (2007). Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy. Anaesthesia 62(6): 555–560.Google Scholar
Ayoub, C, Girard, F, Boudreault, D, et al. (2006). A comparison between scalp nerve block and morphine for transitional analgesia after remifentanil-based anesthesia in neurosurgery. Anesth Analg 103(5): 1237–1240.Google Scholar
Jirarattanaphochai, K, Jung, S, Thienthong, S, Krisanaprakornkit, W, Sumananont, C (2007). Peridural methylprednisolone and wound infiltration with bupivacaine for postoperative pain control after posterior lumbar spine surgery: a randomized double-blinded placebo-controlled trial. Spine 32(6): 609–616; discussion 617.CrossRefGoogle ScholarPubMed
Bala, I, Gupta, B, Bhardwaj, N, Ghai, B, Khosla, VK (2006). Effect of scalp block on postoperative pain relief in craniotomy patients. Anaesth Intensive Care 34(2): 224–227.Google Scholar
Hernández Palazón, J, Doménech Asensi, P, Burguillos López, S, et al. (2007). [Cranial nerve block with bupivacaine for postoperative analgesia following supratentorial craniotomy]. Rev Esp Anestesiol Reanim 54(5): 274–278.Google ScholarPubMed
Law-Koune, JD, Szekely, B, Fermanian, C, et al. (2005). Scalp infiltration with bupivacaine plus epinephrine or plain ropivacaine reduces postoperative pain after supratentorial craniotomy. J Neurosurg Anesthesiol 17(3): 139–143.CrossRefGoogle ScholarPubMed
Nguyen, A, Girard, F, Boudreault, D, et al. (2001). Scalp nerve blocks decrease the severity of pain after craniotomy. Anesth Analg 93(5): 1272–1276.Google Scholar
Trivedi, JR, Silvestri, NJ, Wolfe, GI (2013). Treatment of painful peripheral neuropathy. Neurol Clin 31(2): 377–403.Google Scholar
Murray, MJ, Cowen, J, DeBlock, H, et al. (2002). Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 30(1): 142–156.Google Scholar
Greenberg, SB, Vender, J (2013). The use of neuromuscular blocking agents in the ICU: where are we now? Crit Care Med 41(5): 1332–1344.CrossRefGoogle ScholarPubMed

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