Sedation and Analgesia

Sedatives and analgesics have specific indications in the neurocritical care unit (NCCU) in addition to their general indications to alleviate anxiety, pain, and discomfort, avoid agitation, and facilitate mechanical ventilation. The cerebral metabolic requirement is decreased by sedatives, improves brain tolerance to ischemia, and serves as a cornerstone of treatment for seizures and intracranial hypertension. Although recommendations are not well established, different sedation techniques are used in the NCCU. The main mechanisms of action, specific cerebral effects, drug-related complications, benefits, drawbacks, and comparative effects of sedatives (propofol, benzodiazepines, and barbiturates), analgesics (morphine, fentanyl, sufentanil, and remifentanil), and adjunct agents (dexmedetomidine and ketamine), which are used in the NCCU, are summarized in this chapter. Control of intracranial pressure, preventing additional brain ischemic/hypoxic insults, and other specific issues are given special attention. The management of sedation and analgesia in individuals with acute brain damage is addressed using a practical approach.