Sedation It's a Routine Practice It's Telling You Roughly It's Something Frequent, Important So Don't Be Afraid.
All the experts for a recommendation agree that the analgesia in this case must be the priority that the pain must be evaluated and less pain is less sedation and therefore perhaps fewer side effects and of toxicity and finally that we must also prevent the phenomenon of Delirium which is a complication we will say these days in intensive care that it probably associated with morbidity or even mortality.
Sedation is used whose purpose is to reduce respiratory distress and promote adaptation to VM, moreover sedation reduces O2 consumption and CO2 production (in shock). -injured protected the brain (edema, ischemia) and then obviously we are perhaps less aware that it is to reduce anxiety.
Sedation is widely used in resuscitation services and by SAMU doctors, it allows the patient to endure and not be aware of what is happening for a period of time. In addition, certain pathologies (such as epileptic / convulsive disease) requiring sedation to end the symptoms.
Palliative sedation is called when the patient begins to lose consciousness with medication to relieve the burden and pain. Doctors speak in this case of continuous or deep palliative sedation.
Palliative sedation can be deep or light. In the case of light sedation, the patient may appear to be sleeping but he can speak and touch things.
In case of deep sedation, the patient sleeps completely, he can do no action.
When the doctor cannot reduce the patient's state of consciousness, the situation must meet a certain number of (medical) criteria. In particular, there must be no other way to deal with moans. , and the doctor must estimate that death is near (one to two weeks).
Continuous or deep sedation, there is also a brief form of palliative sedation. In this case, the doctor puts the patient to sleep for a few hours (day or night). In this case, we will generally discuss “sleep” or “time-out”. This form of palliative sedation can make the death patient (more) bearable.
Generally sedation is acquired by drugs from the class of hypnotics. That they are (midazolam, lorazepam, bromazepam). Never forget propofol, ketamine or thiopental.
In daily practice, it is rare to dissociate sedation from analgesia which is the management of the painful component. Analgesia is a set of drugs derived from morphine: remifentanil, sufentanil, alfentanil, fentanyl.
Recommended Medication Therapies
- It is a drug of choice for terminal sedation for distress:
- By its accommodation and reversibility (short half-life of 2 to 4 hours)
- By its therapeutic safety margin (sedative effect 20 to 60 minutes depending on the dosage)
- By its ease of use (IV or SC) and its minimum cost
- It poses many problems of use:
- Strict route IV preferably central
- Large administration volume requiring frequent handling
- Respiratory and cardio-circulatory depression
- 12 hour retention period after opening
Specific indication for terminal agitation syndromes.
Practical modalities of sedation
A significant number of questions are asked concerning sedation, to guarantee a coherent approach between the ethical aim and the implementation of the decision taken.
Respiratory constraints, hypotension and apnea are frequent complications of sedation.
Anesthesia and resuscitation: perioperative management (before, during and after surgical operation) of patients. This comprehensive care is based on a preoperative assessment. During the intervention, the anesthesiologist will admonish the pain by the use of analgesics, possibly sedating the patient (to avoid memorization) using hypnotics and in some cases relaxing all of his muscles to using curares. It is then a general anesthesia.
Regional anesthesia consists of falling asleep only part of the body (arm, leg, sub-umbilical region) to allow a dashing patient to perform surgery limited to the blocked (anesthetized) region.
During the surgical procedures, the comfort of the patient and the good progress of the operation are ensured in an excellent way thanks to the anesthesia, and it is initially the dentists who, effectively relieved their contemporaries. This is called therapeutic anesthesia, and it can be general, regional or local.
The most important thing is to remove the pain and protect the patient from physiological disturbances induced by the surgical procedure. The patient undergoes three successive phases:
Bear the pain, or analgesia;
Sleep, or narcosis;
Absence of reflexes and muscle relaxation facilitating the work of the surgeon.
When the anesthesia begins to disappear, the patient automatically goes back through the second and then through the first phase; finally, he regains consciousness and does not remember anything. This postoperative aphasia is partly due to the administration of drugs before the intervention.