Analgesia, sedation, and neuromuscular blockade during targeted temperature management after cardiac arrest.

Document Type

Article

Publication Date

2015

Institution/Department

Critical Care; Pharmacy

Journal Title

Best practice & research. Clinical anaesthesiology

MeSH Headings

Analgesia, Body Temperature, Disease Management, Heart Arrest, Humans, Hypnotics and Sedatives, Hypothermia, Induced, Neuromuscular Blockade

Abstract

The approach to sedation, analgesia, and neuromuscular blockade during targeted temperature management (TTM) remains largely unstudied, forcing clinicians to adapt previous research from other patient environments. During TTM, very little data guide drug selection, doses, and specific therapeutic goals. Sedation should be deep enough to prevent awareness during neuromuscular blockade, but titration is complex as metabolism and clearance are delayed for almost all drugs during hypothermia. Deeper sedation is associated with prolonged intensive care unit (ICU) and ventilator therapy, increased delirium and infection, and delayed wakening which can confound early critical neurological assessments, potentially resulting in erroneous prognostication and inappropriate withdrawal of life support. We review the potential therapeutic goals for sedation, analgesia, and neuromuscular blockade during TTM; the adverse events associated with that treatment; data suggesting that TTM and organ dysfunction impair drug metabolism; and controversies and potential benefits of specific monitoring. We also highlight the areas needing better research to guide our therapy.

ISSN

1878-1608

First Page

435

Last Page

450

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