Sedation and Analgesia in Neurocritical Patients

Pain, anxiety, agitation, and delirium are common in neurological critically ill patients. Neglecting pain treatment may jeopardize recovery from neurologic illnesses and is related to unnecessary suffering, agitation, fear, depression, decreased participation in physical and mental activities, slow recovery, and systemic stress response, among other cognitive and systemic complications. Adequate analgesia and sedation provide comfort, amnesia, agitation, and anxiety relief. Besides there are improvements of care and the adaptation to ventilation support, a decrease of the metabolic rate of oxygen (CMRO2) and blood flow (CBF), and control of intracranial pressure (ICP). Comprehensive evaluation is essential to promote adequate analgesia and sedation. The aim is to keep patient comfortable without interference in medical judgment nor causing deterioration or aggravation of the clinical and neurological status. The physicians should be aware of the effects of the analgesic and sedative drugs on neurological function, brain physiology, cerebral metabolism, intracranial hemodynamic, cerebrospinal fluid hydrodynamics, and ICP to obtain the benefits avoiding complications.