Yoğun bakımda sedasyon ve analjezi

Purpose: Providing an effective analgesia and adequate sedation is the generally accepted goal of intensive care medicine. In this study, our main aim is to assess the effects of sedation and analgesia scales in sedo-analgesia treatment, to comperatively evaluate fentanyl and remifentanil in terms of hemodynamic parameters, organ dysfunction and adverse effects and also to throw light on and make suggestions regarding the future possible role of a clinical pharmacist in the intensive care unit (ICU) settings.Materials and Methods: This study was a prospective, randomized, open-label and controlled trial that was conducted in the ICU of Ministry of Health Göztepe Research & Teaching Hospital in Istanbul, Turkey. Thirty-four patients were included and the patients were randomly allocated to one of two groups. All of the patients were provided with mechanical ventilation by Simultaneously Intermediate Mechanical Ventilation / Volume Control (SIMV/VC) mode. In total, 34 patients received either a remifentanil-midazolam regimen (R group, n=17) or a fentanyl-midazolam regimen (F group, n=17) to provide analgesia and sedation in the ICU. After the protocol was initiated, daily interruption of analgesia and sedation therapy was performed. Midazolam dosage was adjusted according to the Ramsey (RS) and Riker Sedation-Agitation (SAS) scales, doses of remifentanil and fentanyl were adjusted according to Behavioral?Physiological Scale (BPS). Vital signs (MAP, CVP, HR, body temperature), blood gases (PaO2, PaCO2, SpO2, pH), liver functions (ALT, AST) and also kidney functions (BUN, SCr) were recorded every two hours on the first day of admission and every six hours thereafter.Results and Conclusion: Statistically no significant differences were observed between remifentanil and fentanyl with respect to hemodynamic parameters, organ dysfunction and adverse effects (p>0.05). Regarding length of mechanical ventilation, sedation time and length of ICU stay, there were no significant differences between R and F groups(p>0.05). Using sedation and analgesia assessment scales such as SAS, RS and BPS is essential in order to provide optimum sedation and analgesia. In addition, a strong correlation between SAS and RS was found in this study. The formation of a intensive care team consisting of physicians, clinical pharmacists and nurses is very important in order to provide good pharmaceutical care to the ICU patients. Some of the major drug related problems in ICU settings are polypharmacy, incompatibility, adverse drug reactions and dose monitoring. These problems might be managed with the contribution of a clinical pharmacist. Further studies could focus on defining the role and benefits of the clinical pharmacist within the ICU team.Key Words: Sedation & Analgesia, Remifentanil, Fentanyl, Intensive Care Unit, Clinical Pharmacist