Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000500016
Brazilian Journal of Anesthesiology
Artigo de Revisão

Sedação e analgesia em terapia intensiva

Sedation and analgesia in intensive care

Fábio Ely Martins Benseñor; Domingos Dias Cicarelli

http://dx.doi.org/10.1590/S0034-70942003000500016 Braz J Anesthesiol, vol.53, n5, p.680-693, 2003
PDF
Downloads: 7
Views: 1546

Resumo

JUSTIFICATIVA E OBJETIVOS: A ansiedade e a dor podem causar maior desconforto e risco aumentado de complicações no pós-operatório de pacientes cirúrgicos, prolongando inclusive seu tempo de internação. O objetivo deste estudo foi revisar os conceitos de sedação e analgesia em terapia intensiva, atualizando os conhecimentos e permitindo a revisão das informações disponíveis na literatura, assim como os consensos já publicados. CONTEÚDO: Apresentamos separadamente a sedação e analgesia, revisando cada grupo de fármacos disponível na prática clínica, suas características principais bem como seus efeitos colaterais mais importantes. Acrescentamos alguns protocolos utilizados em nossa UTI para analgesia e sedação, assim como as conclusões do último consenso do Colégio Americano de Medicina Intensiva e da Sociedade Americana de Terapia Intensiva. CONCLUSÕES: Apesar do grande arsenal terapêutico disponível na prática clínica, nota-se um grande desconhecimento das principais características dos fármacos utilizados para sedação e analgesia em terapia intensiva. Os consensos realizados tentam difundir as qualidades e efeitos colaterais dos fármacos mais utilizados, normatizando seu uso, tornando a analgesia e sedação realizadas nas UTI, procedimentos que beneficiem e recuperem mais rapidamente os pacientes.

Palavras-chave

ANALGESIA, SEDAÇÃO, TERAPIA INTENSIVA

Abstract

BACKGROUND AND OBJECTIVES: Pain and anxiety may cause major discomfort, increase the risk for postoperative complications in surgical patients and may even prolong their hospital stay. This study aimed at reviewing concepts of sedation and analgesia in intensive care, updating knowledge and reviewing information available in the literature as well as already published consensus. CONTENTS: Sedation and analgesia are presented in separate, reviewing each group of available drugs, their major characteristics and side-effects. We have included some protocols used in our ICU for analgesia and sedation as well as the conclusions of the latest consensus of the American College of Critical Care Medicine and the Society of Critical Care Medicine. CONCLUSIONS: In spite of the therapeutic armamentarium available, there is a lack of understanding about major characteristics of drugs used for sedation and analgesia in Intensive Care. Developed consensus try to explain qualities and side-effects of most popular drugs, normalizing their use for ICU analgesia and sedation to benefit and faster recover patients.

Keywords

ANALGESIA, INTENSIVE CARE, SEDATION

Referências

Crippen D, Ermakov S. Continuous infusions of haloperidol in critically ill patients. Crit Care Med. 1995;23:214.

Cheng E. The cost of sedating and paralyzing the critically ill patient. Crit Care Clin. 1995;11:1005.

Tesar G, Stern T. Evaluation and treatment of agitation in the intensive care unit. J Intens Care Med. 1986;1:137.

Riker RR, Fraser GL, Cox PM. Continuous infusion of haloperidol controls agitation in critically ill patients. Crit Care Med. 1994;22:433.

Parker SE, Davey PG. Pharmacoeconomics on intravenous drug administration. Pharmacoeconomics. 1992;1:103.

Kollef MH, Levy NT, Ahrens TS. The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest. 1998;114:541.

Hersch M. Continuous IV sedation and mechanical ventilation. Chest. 1999;115:1220.

Sfeir TA. Continuous IV sedation and mechanical ventilation. Chest. 1999;115:604.

Rall TW. Hipnóticos e Sedativos: Etanol. As Bases Farmacológicas da Terapêutica. 1991:345-382.

Omoigui S. The Anesthesia Drugs Handbook. 1995:198-199.

Negrão Filho T. Tratamento da Hipertensão Intracraniana. Atualização em Medicina Intensiva. 2002;4:15-18.

Stoltzfus DP, Durbin CG. The Use of Sedative, Analgesic and Neuromuscular Blocking Agents in the Intensive Care Unit. Critical Care Medicine: Perioperative Management. 1997:109.

Marinella MA. Propofol for sedation in the intensive care unit: essentials for the clinician. Respir Med. 1997;91:505.

Fulton B, Sorkin EM. Propofol: an overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs. 1995;50:636.

Valente JF, Anderson GL, Branson RD. Disadvantages of prolonged propofol sedation in the critical care unit. Crit Care Med. 1994;22:710.

Cray SH, Robinson BH, Cox PN. Lactic acidemia and bradyarrhytmia in a child sedated with propofol. Crit Care Med. 1998;26:2087-2092.

Metzger E, Friedman R. Prolongation of the corrected QT and Torsades de pointes cardiac arrhythmia associated with intravenous haloperidol in the medically ill. J Clin Psychopharmacol. 1993;13:128.

Spencer EM, Willats SM. Isoflurane for prolonged sedation in the intensive care unit: efficacy and safety. Intensive Care Med. 1992;18:415.

Kong KL, Willats SM, Prys-Roberts C. Plasma cathecolamine concentration during sedation in ventilated patients requiring intensive therapy. Intensive Care Med. 1990;16:171.

Giannini A, Salvo I. Isoflurane sedation for critically ill patients. Intensive Care Med. 1993;19:429.

Schlute-Tamburen AM, Scheier J, Briegel J. Comparison of five sedation scoring systems by means of auditory evoked potentials. Intensive Care Med. 1999;25:377.

Shapiro BA. Practice parameters for critical care medicine: what are they and why do we need them?. Crit Care Med. 1995;23:1458.

Collins P, Greely JL. Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Crit Care Med. 1996;24:367.

Petty TL. Suspended life or extending death?. Chest. 1998;114:360.

Manica JT. Anestesiologia: Princípios e Técnicas. 1994:480-481.

Stanley TH, Allen SJ, Bryan-Brown CW. Sleep, Pain and Sedation. Critical Care. 1989:1155-1169.

Rodrigues Jr GR, Amaral JLG. Impacto psicológico da internação na UTI. Rev Bras Anestesiol. 1996;46:121.

Amaral JLG, Issy AM, Conceição NA. Recomendações da Associação de Medicina Intensiva Brasileira sobre Analgesia, Sedação e Bloqueio Neuromuscular em Terapia Intensiva. 1999.

Teixeira MJ, Côrrea CF, Pimenta CAM. Dor: Conceitos Gerais. 1994:42-55.

Brown DL, Flynn JF, Owens BD. Pain Control. Critical Care. 1992:219-229.

Gozzani JL. Opióides e antagonistas. Rev Bras Anestesiol. 1994;44:65-73.

Forth W, Beyer A, Peter K. Alívio da Dor. 1995:62-66.

Macedo MAA, Holanda RB, Romero MN. Estudo comparativo dos efeitos colaterais dos opióides por via epidural. Rev Bras Anestesiol. 1997;47:17.

Shapiro BA, Warren J, Egol AB. Practice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Crit Care Med. 1995;23:1601-1605.

Practice Parameters for Intravenous Analgesia and Sedation for Adult Patients in the Intensive Care Unit: An Executive Summary. Fundamental Critical Care Support Course Text. 1998:241-251.

5ddc471e0e88254d32f2c920 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections