TY - CHAP M1 - Book, Section TI - Chapter 50. Pain Control, Sedation, and Neuromuscular Blockade A1 - Kress, John P. A1 - Hall, Jesse B. A2 - Tobin, Martin J. PY - 2013 T2 - Principles and Practice of Mechanical Ventilation, 3e AB - Mechanically ventilated patients often require sedatives and analgesics, and in some circumstances may even require the addition of neuromuscular blockade. The myriad disease processes causing respiratory failure frequently elicit a sense of respiratory distress in these patients. In addition, therapies such as endotracheal intubation and positive-pressure ventilation bring about discomfort to a significant number of patients in the intensive care unit (ICU), and patients often receive these life support treatments after surgical interventions or medical conditions that themselves carry a burden of pain. Accordingly, most patients receive analgesics and/or sedatives while undergoing mechanical ventilation. Although many drugs are available to carry out the goals of pain control and, if necessary, sedation in the ICU, studies of the use of these agents were initially performed in other settings such as the operating room or procedure suite. However, accumulation of evidence directed at ICU patient outcomes—specifically patients undergoing mechanical ventilation—has increased over recent decades, and awareness of the complex pharmacology of sedatives and analgesics in critical care is now well established. At the same time, heightened awareness of the complications associated with the use of neuromuscular blocking agents has relegated their use to mostly short-term indications, such as general anesthesia in the operating room, with ICU use now reserved for a small population of patients, typically suffering from severe acute respiratory distress syndrome. The drugs used to achieve analgesia and sedation of mechanically ventilated patients are necessarily potent; however, the enduring effects when these drugs are used without discretion has impacted strategies for their administration. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/10/04 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=57077812 ER -