Increase of requirements to an intensive care and intensive observation quite logically caused growth of requirements to comfort of the patient in intensive care unit. The patients who are in intensive care unit often have a stress owing to an unusual situation, need of performance of various manipulations, the round-the-clock observation and a set of other stressors. It is important to note that the comfort of the patient during his stay on a resuscitation bed considerably affects result of treatment of such patients. It is one more reason for which such attention is paid to sedation and an analgesia at critical patients.
Sedation — achievement at the patient of a condition of tranquility which can vary from reduced emotional reaction to external irritants to rather deep dream. For monitoring of depth of sedation in an intensive care various scales and the systems of assessment are used.
Sedation of patients in intensive care unit has to meet certain requirements as its use should not stir a main objective - stabilization of vital functions. First, the used drugs has to influence minimum a hemodynamics, or their influence has to be submitted correction easily. Secondly, sedation has to be most operated, that is give the chance in need of the patient quickly to wake, for example, for carrying out objective neurologic survey. Thirdly, sedative drug has to be whenever possible chemically inert and not react with the drugs used in treatment of the patient.
The intravenous way of administration of sedative drugs is usually used. Inhalation sedation on which there were many publications (use of Anaconda prefixes) recently now continues to be studied. The intramuscular way of introduction in intensive care unit has to be used as seldom as possible as it rather painful and is unpredictable in respect of drug pharmacokinetics, besides, can be followed by various complications. Intravenous titration of drug with constant control of its effect remains the basic.
Propofol — one of the most widespread drugs for sedation. Its advantages is high extent of control of effect, almost total absence of clinically significant cumulation and the fast termination of sedation after cutoff of drug and also good tolerance by the patient. Its big expense, negative impact on a hemodynamics, a possibility of development of a syndrome of long infusion of a propofol which worsens the forecast belong to shortcomings of a propofol. It is appointed only in the form of continuous intravenous infusion which speed is selected for clinical effect.
Midazolam — one more widely used drug for sedation of patients in intensive care unit. It is water-soluble benzodiazepine which differs in low cumulative effect that allows to interrupt if necessary sedation and in several hours to get rid of its residual effect. The specific antagonist has — flumazenit. On an expense considerably wins against a propofol as for achievement of clinical effect smaller volumes of the administered drug are required considerably that also facilitates work of paramedical staff. Possesses considerably smaller negative action on a hemodynamics in comparison with other sedative drugs. It is appointed only in the form of continuous intravenous infusion. In a situation of lack of intravenous access perhaps intramuscular introduction before achievement of effect, with the subsequent transition to intravenous infusion. At children this drug can be used orally, for example, for premedication before an operative measure.
Sodium thiopental — the drug spread in the former Soviet Union for sedation of patients in intensive care unit which popularity is connected with its availability in intensive care units and low cost. However for long sedation this drug is unsuitable for a number of reasons, in particular because of the expressed cumulative effect and negative impact on a hemodynamics. Therefore sodium thiopental use in modern conditions for long sedation is not recommended. This drug can be used quickly, for example, for stopping of the epileptic status.
In addition to sedation, in intensive care units considerable attention has to be paid to anesthesia of patients. Now the wide range of techniques which include a multimodal analgesia, regional ways of anesthesia and also their combination is used.