Explain Sedationin details?
Intubation and mechanical ventilation is associated with a significant degree of discomfort. In addition, many of the procedures done routinely in ICUs carry with them pain and discomfort - suctioning, cannulation, etc. Hence, it is important give pain relief and administer sedation as appropriate. This is conveniently done as a continuous infusion of a narcotic + benzodiazepine (morphine + midazolam or fentanyl + midazolam). Besides, adequate explanations should be given before every procedure. Sedation should be stopped routinely in the morning to allow the patient to waken up and assess neurological status before restarting. This would prevent accumulation of long acting sedatives and allow earlier weaning and extubation and thereby, shorten ICU stay. Earlier, it was considered necessary to use muscle relaxants all the time for patients on mechanical ventilation. This is no longer true with the newer modes like pressure support that allow partial as well as full ventilator support and preserves spontaneous breathing. Some degree of spontaneous breathing is always preferable as this would allow diaphragmatic activity, prevention of basal collapse and also reduce the incidence myopathies associated with the use of long acting muscle relaxants.