Semin Neurol 2008; 28(5): 611-630
DOI: 10.1055/s-0028-1105970
© Thieme Medical Publishers

Sedation and Pain Management in Acute Neurological Disease

Marek A. Mirski1 , John J. Lewin2
  • 1Neurosciences Critical Care Unit/Neuroanesthesiology, The Johns Hopkins University, Baltimore, Maryland
  • 2Departments of Pharmacy Services and Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Publication History

Publication Date:
29 December 2008 (online)

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ABSTRACT

The optimum provision of pharmacological sedation of the critically ill neurological patient requires defining the underlying etiology of agitation or need for sedation to determine the optimal agent: pain management, anxiolysis, or treatment of delirium. An appropriate regimen can then be decided upon based on the profiles of action of the several common classes of sedative agents. Methods to both evaluate the efficacy of sedation as well as titration to a predefined clinical goal are important tools toward safe administration of drugs that often have serious adverse effects. Recognition of an individualized approach is also necessary as patients will vary considerably with respect to the kinetics and pharmacodynamics of sedative therapy. The drug classes often selected for sedation in an intensive care unit will be reviewed as well as the metrics by which physicians can achieve their objectives in a safe manner.