Sedation / Delirium Flashcards
Mechanism of PRIS
Impaired oxidative phosporylation of the mitochondria
Free fatty acid utilisation
Features of PRIS
Met acidosis Arrhythmias (Brady) High lipids Renal and hep failure Rhabdo
Risk factors for PRIS
Young age Head injury Sepsis High catecholamine level High glucocorticoid levels Low carb/high lipid intake
Propofol dose to prevent PRIS
4mg/kg/hour
Potential monitoring for PRIS
Daily CK
Triglycerides
Evidence for dexmed
Is non-inferior to all usual sedative
Reduced delirium compared to lorazepam (MENDS study) and Midaz (MIDEX study)
No difference in MV duration compared to propo (PRODEX study)
Patients can communicate pain better compared to prop and midaz
Can dexmed be used for deep sedation
No
Ketamine side effects in ITU
Sympathetic stimulation
Bronchodilation
Preserved cough reflex
Muscle rigidity
Hallucinations
Delirium definition
Acute onset
Fluctuating mental stage and
Disorganised thinking
OR
Altered level of conciousness
Types of delerium
Hyperactive (agitated, restless, paranoid)
Hypoactive (lethargic, inattentive, “pleasantly confused”)
Mixed (fluctuate between two)
Which is the least common form of delirium
Hyperactive…
Incidence of deliriu
As high as 83%
Effects of delirium
Increased hospital LOS
Increased 6/12 month mortality
Neurocognitive issues in survivors
Is there a role for prophylactic antipsychotics in delirium
No
What is the scoring system for RASS, what is normal?
+4 to -5
+4 combative
-5 Unrousable
0 normal
Scoring system for Ramsey scale
1 - 6
2 is co-operative
1 anxious/agitation
6 unrousable
Scoring system fro Ryker
1-7
1 unrousable
7 dangerous agitation
4 calm
Propofol mechanism
? positive modulation of GABA at GABAan receptor
Hyperpolarisation –> chloride influx
Propofol PKs
Highly protein bounf 98% albumin
Fast onset/offset
High clearence
Accumulates in tissues
Propofol PDs
Decreased SVR
Decreased CO and BP
Resp depression
Antitussive
Adverse effect Propofol
PRIS
Pain on bolus
High lipids