Sedating dose

There are many clinical scoring systems in use within the UK; examples include the Ramsay, Addenbrookes, and the Bloomsbury scales (Table 1).Each of these gives a quantitative score to a clinical finding in the awake or asleep state.Ketamine is a phencyclidine derivative that antagonizes the excitatory neurotransmitter glutamate at NMDA receptors.It produces a state of dissociative anaesthesia, profound analgesia, and amnesia. Ketamine is not commonly used as a sedative infusion due to sympathetic nervous system stimulation resulting in increased cardiac work and a rise in cerebral metabolic oxygen consumption. Concerns include extrapyrimidal effects and hypotension from peripheral α It is metabolized in the liver to products with minimal activity; only 1% is excreted unchanged in the urine.Thiopental is now only administered by continuous infusion in the management of refractory status epilepticus.It has a low clearance and, when given as an infusion, its metabolism may become linear (zero order) due to saturation of hepatic enzymes; thus accumulation is a serious concern, and may lead to myocardial depression and immunosupression.

In a ventilated patient, this is often multifactorial, and thus a combination of pharmacotherapy may be required.When considering combinations of drugs, knowledge of their context sensitive half-times is essential.Propofol is extensively used in the intensive care setting as a sedative.This includes frequent communication and explanation to the patient by all staff directly involved in their care, both nursing and medical, and relatives.Physiotherapy plays an important role as prolonged immobility may be painful and this can be reduced by daily assessment and treatment.

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