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Metabolic and Endocrine Effects of Sedative Agents

 

Mistraletti G, Donatelli F, Carli F

 

Curr Opin Crit Care 11:312—317

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Purpose of review: To bring to the attention of the clinician the metabolic effects of most common sedatives and analgesics used in critically ill patients.

Recent findings: Most patients admitted to the intensive care unit require sedation and analgesia to reduce anxiety, agitation, and delirium and provide pain relief. Inappropriate sedation and analgesia techniques can cause harm to the already compromised patient if they do not take into account the metabolic effect they produce. * @link http://www.joomlatools.com */ defined('KOOWA') or die; ?> icon && (!isset($show_icon) || $show_icon !== false)): ?> * @link http://www.joomlatools.com */ defined('KOOWA') or die; ?> pdf size && (!isset($show_size) || $show_size !== false)): ?> (86 KB)

Summary: Metabolically critical illness can be divided in two phases, and acute and a prolonged one. Whereas the acute or hypermetabolic phase is characterized by elevated circulating concentration of catabolic hormones and substrate utilization to provide energy to vital organs, the prolonged or catabolic phase of critical illness is marked by reduced endocrine stimulation and severe loss of body cell mass. The most common analgesic and sedative agents used in the intensive care unit, if used in small or moderate doses, do not interfere significantly with the metabolic milieu; however, prolonged infusions, and in high doses, without adequate monitoring of level of sedation and quality of analgesia, can precipitate morbid events. Further research is needed in the metabolic aspects of analgesia and sedation in the intensive care unit, particularly if a multimodal pharmacologic strategy is used whereby multiple interventions aim at minimizing the risk of overdosing and contributing to attenuation of the stress response associated with critical illness. * @link http://www.joomlatools.com */ defined('KOOWA') or die; ?> icon && (!isset($show_icon) || $show_icon !== false)): ?> * @link http://www.joomlatools.com */ defined('KOOWA') or die; ?> pdf size && (!isset($show_size) || $show_size !== false)): ?> (86 KB)

 

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In Terapia Intensiva collaborano molte persone con ruoli diversi. Solo grazie al contributo di tutti, pazienti compresi, si possono raggiungere risultati eccellenti.

Link veloci

Gestire il dolore

ico-flowchartdoloreFlowchart dolore
ico-vnrVNR
ico-bpsBPS

Gestire la sedazione

ico-flowchart-sedaz-agitFlowchart sedaz/agitaz
ico-rassRASS

Gestire il delirium

ico-flowchart-deliriumFlowchart Delirium
ico-manuale-cam-icuManuale CAM-ICU
ico-schedalavoro-cam-icuScheda di lavoro CAM-ICU
ico-icdscICDSC

 

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