Analgesia, Sedation & Paralysis

Question 1

What are the general analgesia options for self-ventilating patients?

Answer 1

Oral therapy

regional anaesthesia

Question 2

What are the benefits of avoiding sedation in patients?

Answer 2

Can communicate needs

Early recognition of side effects

Question 3

When is it appropriate to heavily sedate patients?

Answer 3

Intra-cranial pressure reduction

Invasive ventilation

Question 4

In unconscious sedated patients, how is distress recognised?

Answer 4

1. hypertension
2. lacrimation
3. sweating
4. tachycardia

Question 5

How is the level of paralysis determined in patients?

Answer 5

Electric nerve stimulation

Question 6

What are the risks of paralysing patients?

Answer 6

extubation - nearly always fatal

Question 7

What scoring system is used to assess level of sedation?

Answer 7

Ramsay Score

Question 8

What drugs are recommended in level 2 of the WHO step ladder for analgesics?

Answer 8

1. Paracetamol 1g 4-6 hourly (max 8 tablets)
2. +/- NSAID 200-400mg 6 hourly
3. dihydrocodeine/codeine 30mg 6 hourly

Question 9

In which groups should NSAIDs be used in caution or not at all?

Answer 9

Elderly
diabetics
Renal insufficiency
Decreased urine output
hypotension
Peptic Ulcer

Question 10

What drug is usually administered to treat post-operative pain?

Answer 10

Tramadol

Question 11

Morphine + what other drug is used to induce unconsciousness in patients?

Answer 11

Benzodiazapine

Question 12

Alfentanil/Remifentanil is long or short acting?

Answer 12

Short acting

Question 13

How often should administration of sedatives be reviewed in a patient?

Answer 13

A sedative hold should occur at least once a day. All sedatives halted to allow for assessment of neurological function

Question 14

Midazolam belongs to which class of drugs?

Answer 14

Benzodiazepines

Question 15

Higher doses of Midazolam are required in which groups of patients and why?

Answer 15

Alcoholics, epileptics, liver disease (requires liver enzyme induction)

Question 16

What can be substituted for Midazlolam in patients who require a higher dose?

Answer 16

Lorazepam in patients with liver dysfunction

Question 17

Does propofol have a long or short reversal period?

Answer 17

Short

Question 18

In what patients should propofol be used with caution and why?

Answer 18

Haemodynamically unstable patients as it can induce hypotension in 30% of people

Question 19

What sedation score can be used to determine a patients level of sedation?

Answer 19

Ramsay Sedation Score

Question 20

Name for side effects of sedation

Answer 20

1. Confusion + agitation upon withrawal
2. Decreased systemic vascular resistance = hypotension
3. allergic reaction (propofol can contain soya/egg)
4. prolonged sedation = chest infection, neuropathies, venous thromboembolism

Question 21

What infection should you be particularly careful of in ventilated patients?

Answer 21

VAP - ventilator acquired pneumonia

Question 22

Name 5 indications for use of paralytic agents

Answer 22

1. ET insertion (initial only)
2. difficult ventilation (Asthma, ARDS)
3. reduced oxygen consumption in ICU
4. To reduce ICP in TBI
5. control status epilepticus

Question 23

Sexemethoneum/ Succenylcoline have what side effect on the body? Hence what patient can they not be used in?

Answer 23

1. They induce the release of K+ –> can’t be used in renal, burns or trauma patients
2. Bradycardia & vagal stimulation –> not recommended in patients with CVD

Question 24

Atricarium has what effect on the body?

Answer 24

A paralytic agent

Question 25

What side effect does atricarium have, hence who should it be used in caution with?

Answer 25

histamine release causing bronchospasm –> caution in asthmatics, COPD etc