Makindo Medical Notes

Related Subjects: |Analgesia |Sedation and Analgesia on ITU |Codeine |Dihydrocodeine |Diamorphine |Morphine

🛌 Sedation and Analgesia in Intensive Care (ITU)

Sedation and analgesia are central to the management of critically ill patients in ITU. They ensure comfort, facilitate invasive therapies such as mechanical ventilation, and reduce stress responses. However, their use must balance efficacy against risks including hypotension, prolonged ventilation, delirium, and withdrawal.

Analgesia and sedation are often used together but should be considered separately: analgesia first ➝ pain relief is the priority, sedation second ➝ to aid tolerance of invasive interventions.

💉 Analgesia in ITU

Opioids remain the cornerstone of analgesia in critically ill patients. They provide both pain relief and a degree of sedation, but vary in their pharmacokinetics.

Teaching point: Always titrate opioids to effect. Clearance may be altered by renal/hepatic dysfunction, and tolerance develops with prolonged use.

💤 Sedation in ITU

Sedatives provide anxiolysis and facilitate tolerance of intubation, ventilation, and invasive monitoring. The choice of agent depends on context: haemodynamic stability, delirium risk, and expected duration of sedation.

Teaching point: Target sedation depth with a scoring system such as RASS (Richmond Agitation-Sedation Scale). Daily “sedation breaks” help reduce delirium and aid earlier ventilator weaning.

⚖️ Balancing Analgesia and Sedation

• ✅ Start with analgesia first – pain drives agitation and tachycardia.
• ➕ Add sedation only if required for tolerance of ventilation/procedures.
• ⛔ Avoid deep sedation unless indicated (e.g. raised ICP, severe ARDS).
• 💡 Modern practice: “analgesia-based sedation” – optimise opioids, then add light sedation (often Propofol).

🚨 Complications to Monitor

• 💔 Hypotension (propofol, high-dose opioids)
• 😮‍💨 Respiratory depression
• 🌀 Delirium (especially with benzodiazepines)
• 🔄 Withdrawal syndromes with prolonged use
• ☠️ Propofol Infusion Syndrome (rare but life-threatening)

📚 Key Takeaways for Exams & OSCEs

• 🔑 Always separate analgesia vs sedation.
• 💉 Opioids provide analgesia ± sedation (titrate carefully).
• 💤 Propofol = rapid onset/offset but risk of hypotension, PRIS.
• 💊 Midazolam = accumulates ➝ prolonged sedation, delirium risk.
• 🧪 Monitor with RASS, use daily sedation breaks.
• ⚖️ Aim for light sedation unless deeper levels are clinically required.