Critical Analysis of Sedation and Analgesia in Severe Head Trauma

• Published in: Arquivos brasileiros de neurocirurgia Vol. 35; no. 2; pp. 135 - 147
• Main Authors: Rabelo, Nícollas Nunes, Rabelo, Neiffer Nunes, Machado, Fabio Santana, Joaquim, Marcos Augusto Stávale, Dias Junior, Luiz Antônio Araujo, Pereira, Carlos Umberto
• Format: Journal Article
• Language: English
• Published: Rio de Janeiro, Brazil Thieme Publicações Ltda 01.06.2016; Thieme Revinter Publicações Ltda
• Subjects: analgesia; brain injury; intracranial hypertension; Review Article | Artigo de Revisão; sedation; brain injury; sedação; analgesia; intracranial hypertension; hipertensão intracraniana; lesão cerebral; sedation
• ISSN: 0103-5355; 2359-5922
• DOI: 10.1055/s-0036-1582447

Abstract Introduction  Head injury is a direct determinant of morbidity, disability, and mortality in the young population. Sedatives and analgesics are commonly used in patients with brain injury to retrieve an ICP, CMRO2, and CBF, preserving the cerebral regulation system and self-avoiding hypotension. Objective  The objective of this paper is to review on this topic, linking the main drugs, side effects, costs, anxiolytic properties, anticonvulsants, and correlating them with complacency and brain metabolism. Methods  We perform a literature review using PubMed database, MEDLINE, EMBASE, Science Direct, The Cochrane Database, Google Scholar, and Clinical trials. We selected papers from the period between 1958 and 2014, which totaled 254 papers. Of these, we selected 129 papers based on keywords, inclusion, and exclusion criteria. Evidence Review  The volume of the brain decreases due to dislocation of the CBV out of the skull. The main sedatives and analgesics are propofol, midazolam, etomidate, ketamine, barbiturates, dexedetomedina, morphine, fentanyl, alfentanil, sulfenatil, and remifentanil. We hereby discuss the algorithm for a fast intubation sequence and the algorithm for intracranial hypertension treatment regarding the systematic sedation therapy. A range of sedatives and analgesic agents are available for sedation. Each class has its own positive and negative effects on neurotrauma patients. Conclusions  The correct analysis of sedation and analgesia in neurotrauma, rapid sequence intubation, and management of medications in intracranial hypertension can lead to an ideal management of brain injury.