PAD指南在CICU的再解读及EGDS__培训课件.ppt

Conclusions Delivery of early goal-directed sedation was feasible, appeared safe, achieved early light sedation, minimized benzodiazepines and propofol, and decreased the need for physical restraints. 谢 谢 * Sedation/Analgesia: Patient Comfort In the ICU, the ultimate goal of sedation is to achieve patient comfort. This is attained through adequate analgesia and sedation, including amnesia, hypnosis, and anxiolysis. * Sedation/Analgesia: Opioids The opioids are analgesic agents with a secondary effect of anxiolysis. These agents are useful for patients who require pain medication and are agitated as a result of their pain. These agents do not promote hypnosis or amnesia. Harvey MA. Managing agitation in critically ill patients. Am J Crit Care. 1996;5:7-16. * Sedation/Analgesia: Amnesia, Hypnosis, Anxiolysis With Benzodiazepines When selecting an appropriate agent to achieve optimal sedation, the goals should be broken down into their components: amnesia, hypnosis, and anxiolysis. Depending on patient status, agents may be selected to meet each patients needs. For instance, some patients require less anxiolysis than others. In some, amnesia is not important; in others, it is. Thus, an appropriate agent can be selected for each circumstance. Benzodiazepines are potent anxiolytics.1,2 If given in a large enough dose, these agents will induce hypnosis.2 In terms of sedation, the benzodiazepines are effective for amnesia, hypnosis, and anxiolysis.1,2 However, they lack analgesic properties. In fact, attempts to use the benzodiazepines without pain medication could disinhibit cortical control and cause agitation.2 1. Pepperman M. Sedation in the intensive care unit: the benzodiazepines and the benzodiazepine antagonist flumazenil (Anexate). Care of the Critically Ill. 1989;5:195- 199. 2. Harvey MA. Managing agitation in critically ill patients. Am J Crit Care. 1996;5:7-16. * Sedation/Analgesia: Propofol Propofol is an effective anxiolytic agent that induces sleep