ICU 镇静--镇痛与肌松(胡文能).pptVIP

* * * * 不同骨骼肌群对不同非去极化肌松药反应不同，仅以拇收肌的恢复评估神经肌肉恢复的程度并不全面。 受年龄，疾病轻重，手术部位及术中用药影响，肌松用药较为复杂。 中效肌松药能明显减少术后肌松残留 TOF T4/T1=0.7 ? * 3 * * * * * * * * * * * * * * * * Patients admitted to the intensive care unit (ICU) for medical reasons or after surgery generally require sedation to minimise distress due to pain, discomfort and anxiety, to facilitate mechanical ventilation and nursing procedures, and to encourage a normal sleep/wake pattern. Inadequately treated discomfort and agitation can have detrimental medical consequences such as tachycardia, hypertension, myocardial ischaemia and increased oxygen consumption. A sedative agent ideally should have a rapid onset and short duration of action which allows easier titration to and maintenance of the desired level of sedation and quicker emergence from sedation. The ideal sedative would be eliminated by pathways not associated with renal, hepatic or pulmonary function. It would also have minimal depressant effects on the respiratory and cardiovascular system and would not affect the metabolism of other drugs. * * * * * * * Propofol 2% is a ‘double-strength’ formulation of Propofol containing 20 mg/ml propofol compared with Propofol 1% which contains 10 mg/ml propofol. Critically ill patients and patients with sepsis may have an impaired ability to metabolise lipids because of altered enzyme or metabolic pathways and may not be able to tolerate an excessive lipid load.1 A ‘double-strength’ formulation of Propofol (Propofol 2%) would allow the lipid load to be reduced by 50%. Certain types of patients require restriction of fluids as part of their clinical management. These include patients with trauma, sepsis, renal failure, hepatic failure, cardiac failure and head injuries. The development of a ‘double-strength’ formulation of Propofol (Propofol 2%) would enable the fluid volume given to be reduced by 50%. Nursing staff in the ICU may have many patients who require prolonged sedation. As Propofol is usually adminis