Modern Sedation and Analgesia Strategies in Neurocritical Care

Bauerschmidt, Andrew; Al-Bermani, Tarik; Ali, Syed Sohail; Bass, Brittany; Dorilio, Jessica; Rosenberg, Jon; Al‐Mufti, Fawaz

doi:10.1007/s11910-023-01261-7

Cited by 12 publications

(4 citation statements)

References 95 publications

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“…Dexmedetomidine has minimal effect on cerebral hemodynamics, including cerebral blood flow and brain tissue perfusion; however, it may modestly reduce ICP, due to its mild cerebral vasoconstriction effects, reduction in cerebral blood volume and in cerebral metabolic rate [74].…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Procedural Sedation in Emergency Department: A Narrative Review

Cappellini,

Bavestrello Piccini,

Campagnola

et al. 2024

Preprint

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Procedural Sedation and Analgesia (PSA) in the Emergency Department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. Results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. Conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.

show abstract

Section: Mechanism Of Actionmentioning

confidence: 99%

Procedural Sedation in Emergency Department: A Narrative Review

Cappellini,

Bavestrello Piccini,

Campagnola

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Dexmedetomidine has minimal effect on cerebral hemodynamics, including cerebral blood flow and brain tissue perfusion; however, it may modestly reduce ICP due to its mild cerebral vasoconstriction effects and reduction in cerebral blood volume and in cerebral metabolic rate [71].…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Procedural Sedation in Emergency Department: A Narrative Review

Cappellini,

Bavestrello Piccini,

Campagnola

et al. 2024

Emergency Care and Medicine

View full text Add to dashboard Cite

Procedural sedation and analgesia (PSA) in the emergency department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. The results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. The conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and the adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.

show abstract

“…We made observations on different medications that stroke patients received during sleep EEG recordings. Group-1 received propofol, which is one of the most commonly used anesthetics in neurologic intensive care units after stroke or traumatic brain injury (53). It exerts its action by potentiating the activity of chloride currents through GABA receptors while blocking voltage-gated sodium channels (54)(55)(56).…”

Section: Propofol and Levetiracetam: Effect On Sleepmentioning

confidence: 99%

Disturbed laterality of non-rapid eye movement sleep oscillations in post-stroke human sleep: a pilot study

Simpson,

Rangwani,

Abbasi

et al. 2023

Front. Neurol.

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Sleep is known to promote recovery post-stroke. However, there is a paucity of data profiling sleep oscillations in the post-stroke human brain. Recent rodent work showed that resurgence of physiologic spindles coupled to sleep slow oscillations (SOs) and concomitant decrease in pathological delta (δ) waves is associated with sustained motor performance gains during stroke recovery. The goal of this study was to evaluate bilaterality of non-rapid eye movement (NREM) sleep-oscillations (namely SOs, δ-waves, spindles, and their nesting) in post-stroke patients vs. healthy control subjects. We analyzed NREM-marked electroencephalography (EEG) data in hospitalized stroke-patients (n = 5) and healthy subjects (n = 3). We used a laterality index to evaluate symmetry of NREM oscillations across hemispheres. We found that stroke subjects had pronounced asymmetry in the oscillations, with a predominance of SOs, δ-waves, spindles, and nested spindles in affected hemisphere, when compared to the healthy subjects. Recent preclinical work classified SO-nested spindles as restorative post-stroke and δ-wave-nested spindles as pathological. We found that the ratio of SO-nested spindles laterality index to δ-wave-nested spindles laterality index was lower in stroke subjects. Using linear mixed models (which included random effects of concurrent pharmacologic drugs), we found large and medium effect size for δ-wave nested spindle and SO-nested spindle, respectively. Our results in this pilot study indicate that considering laterality index of NREM oscillations might be a useful metric for assessing recovery post-stroke and that factoring in pharmacologic drugs may be important when targeting sleep modulation for neurorehabilitation post-stroke.

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Modern Sedation and Analgesia Strategies in Neurocritical Care

Cited by 12 publications

References 95 publications

Procedural Sedation in Emergency Department: A Narrative Review

Procedural Sedation in Emergency Department: A Narrative Review

Procedural Sedation in Emergency Department: A Narrative Review

Disturbed laterality of non-rapid eye movement sleep oscillations in post-stroke human sleep: a pilot study

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