Wednesday February 1, 2006
Sedation in Neuro-muscular blockade patients
This month issue of American Journal of Critical Care (see reference # 1) has published interviews of 11 patients to determine and describe the remembered experiences, who were given neuromuscular blocking agents (8=vecuronium 3=cisatracurium) and sedatives and/or analgesics (4=propofol 4=midazolam 3=lorazepam) while they were in ICU. Interview was designed with 4 themes.
1) The first theme was back and forth between reality and the unreal, between life and death; the subtheme was having weird dreams.
2) The second theme was loss of control; the 2 subthemes were fighting or being tied down and being scared.
3) The third theme was almost dying, and
4) The fourth theme was feeling cared for.
It was found that, though patients can have positive recollections of nursing care, they can clearly recall experiences that were frightening and unpleasant, recurrent dreams or nightmares, avoidance of medical care and flashbacks or painful memories possibly leading to PTSD (posttraumatic stress disorder).
Are we doing a good job ?
Neuromuscular Blockade / Paralytics guidelines (SCCM 2002)
Sedation/Analgesia guidelines 2002 (SCCM)
Also see our previous pearl on Train of Four (TOF) and BIS monitoring
References / suggested readings: Click to get article/abstract
1. Patients’ Recollections of Therapeutic Paralysis in the Intensive Care Unit - American Journal of Critical Care. 2006;15: 86-94
2. Sedation and Neuromuscular Blockade in the ICU -Chest. 2005;128:477-479