Drugs In Anaesthesia And Intensive Care

Propofol is used sometimes in patients in intensive care units in hospitals to cause unconsciousness. This may allow the patients to withstand the stress of being in the intensive care unit and help the patients cooperate when a machine must be used to assist with breathing. However, propofol should not be used in children in intensive care units.

Sedatives are administered to 85 % of intensive care unit (ICU) patients. The most commonly used sedatives are intravenous benzodiazepines and propofol. These agents are associated with over-sedation in 40 to 60 % of patients, which can lead to prolonged intubation, delirium and drug-induced hypotension. Evidence is increasing that volatile anesthetic agents are associated with faster extubation times, improved cardiovascular stability with no end-organ toxicity in comparison to our standard intravenous agents for short-term critical care sedation. Use of volatile agents within the ICU is a novel technique using a specialized delivery and scavenging system, which requires staff training and cultural acceptance. This pilot randomized controlled trial aims to assess the safety and feasibility of delivering volatile agents for long-term patient sedation in the ICU with limited or no experience of this technique.

Sedation is a cornerstone of patient care within intensive care units (ICU). Sedative and analgesic medications are administered to 85 % of ICU patients to assist tolerance of mechanical ventilation and invasive procedures and to treat anxiety and pain [1]. Current national and international sedation practice predominantly uses systemic opioids to provide analgesia combined with intravenous benzodiazepines (BDZ) in 60 % and propofol in 20 % of patients [2, 3]. Suboptimal sedation is a commonly seen phenomenon in 75 % patients [4]. Under-sedation occurs in 30 % of patients, resulting in agitated patients demonstrating hypercatabolism and hemodynamic instability with a risk of self-harm and accidental extubation. More commonly, over-sedation from high doses is seen in 40 to 60 % of patients [4]. Over-sedation is linked to slow emergence with a delay in the return of airway reflexes, which prolongs the duration of intubation and mechanical ventilation, thereby increasing the risk of acquiring ventilator-associated pneumonia [4, 5]. Elimination of BDZ, propofol, and opioids rely on good synthetic liver and renal function [5]. Deep sedation is compounded by slow clearance of these agents and systemic drug accumulation among ICU patients who are advancing in age and commonly have liver and renal dysfunction. The daily cost of a ventilated patient ranges $ 3500 to 6000, and thus, the economic impact of additional ventilation days attributable to over-sedation is significant [6].

The concept of intravenous anaesthesia was born in 1932, when Wesse and Schrapff published their report into the use of hexobarbitone, the first rapidly acting intravenous drug. Two years later in 1934, sodium thiopental was introduced into clinical practice by Waters and Lundy, and this is still widely used today. A number of other drugs have since fallen in and out of fashion. The commonest drugs currently in use can be classified according to their chemical structure and include:

An infusion of propofol is used commonly to provide sedation for adult patients undergoing minor procedures and on the intensive care unit. It is also the most commonly used drug to provide total intravenous anaesthesia, TIVA. A number of infusion regimes are widely used, but detailed discussion is beyond the scope of this tutorial.

Etomidate causes the least cardiovascular depression of the IV anaesthetic drugs, with only a small reduction in the cardiac output and blood pressure. In the past, etomidate was widely used to induce anaesthesia in the shocked, elderly or cardiovascularly compromised patient. However, more recently it has become less popular (see below).

Critical care began at Mass General with the establishment of the first five-bed Respiratory Intensive Care Unit (RICU) in the United States. Today, Mass General has more than 130 critical care beds, which are organized into nine different intensive care units.

We got talking about anaesthetics, intensive care and lanyards one day. So we combined the colourful designs of the standard drug labels to give something great for people who work with anaesthetics and intensive care to wear at work.

We like being noticed. We notice our drugs by the way they're labelled. So when we wondered, "why not get noticed with a colourful lanyard of anaesthetic and intensive care drug names?" we thought we'd have a bit of fun too. Hence the caffeine-based labels and the silly superdrug names. 781b155fdc