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
Recommended Citation
Riker, Richard R; Gagnon, David J; May, Teresa; Seder, David B; and Fraser, Gilles L, "Analgesia, sedation, and neuromuscular blockade during targeted temperature management after cardiac arrest." (2015). Maine Medical Center. 361.
https://knowledgeconnection.mainehealth.org/mmc/361
