Pain relief and sedation in the intensive care unit

Abstract

p , AIN, fear, and anxiety are common and often overlooked problems in patients in the intensive care unit (ICU). Holland et al 1 have shown that sedative and pain medications are often prescribed to satisfy the expectations of the medical staff or to provide a convenient nursing condition rather than in response to the actual needs and fears of the patient? Pain, fear, and anxiety influence many aspects of the physician-patient relationship. Appropriate relief is often associated with amelioration of the patient's complaints even if the underlying disease is not controlled. Historically, even before the advancement of Western medicine, pain and discomfort have concerned every patient and physician and every attempt was taken to alleviate them, frequently without much success. Despite major advances in technology, pharmacology, and pain management techniques, pain in the ICU patient remains largely underevaluated and poorly treated. Discomfort, pain, fear, anxiety, and sleep deprivation result in physiologic and psychological stress with important sequelae. TM Hemodynamic disturbances from catecholamine release may be manifested as hypertension, tachycardia, and cardiac arrhythmias. A neuroendocrine stress response increases production of adrenocorticoid hormones (corticotropin, cortisol, and aldosterone), angiotensin, antidiuretic hormone, and catecholamines, resulting in hyperglycemia, protein catabolism, fluid retention, and electrolyte disturbances. The negative protein balance can lead to poor wound healing and a depressed immune response. The circadian rhythm is reversed, leading to further neuroendocrine and sleep disturbances, s-7 Psychological consequences of pain include insomnia, depression, anxiety, and psychosis. s-t~ It is not surprising that the posttraumatie stress disorder is increasingly reported among patients with the adult respiratory distress syndrome who have been on ventilators. Moreover, patients who are placed on high doses of opiates and benzodiazepines often subsequently develop acute withdrawal states. PROBLEM AREAS IN CRITICALLY ILL PATIENTS