Modern Sedation and Analgesia Strategies in Neurocritical Care

Authors

Andrew Bauerschmidt, Department of Neurology-Westchester Medical Center, New York Medical College, Valhalla, NY, USA. Andrew.Bauerschmidt@wmchealth.org.Follow
Tarik Al-Bermani, Department of Pulmonary, Critical Care, and Sleep Medicine-Westchester Medical Center, Valhalla, NY, USA.
Syed Ali, Department of Neurology-Westchester Medical Center, New York Medical College, Valhalla, NY, USA.Follow
Brittany Bass, Department of Pulmonary, Critical Care, and Sleep Medicine-Westchester Medical Center, Valhalla, NY, USA.
Jessica Dorilio, Department of Neurology-Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Jon Rosenberg, Department of Neurology-Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Fawaz Al-Mufti, Department of Neurology-Westchester Medical Center, New York Medical College, Valhalla, NY, USA.Follow

Author Type(s)

Faculty, Resident/Fellow

DOI

10.1007/s11910-023-01261-7

Journal Title

Current Neurology and Neuroscience Reports

First Page

149

Last Page

158

Document Type

Article

Publication Date

4-1-2023

Department

Neurology

Abstract

PURPOSE OF REVIEW: Patients with acute neurologic injury require a specialized approach to critical care, particularly with regard to sedation and analgesia. This article reviews the most recent advances in methodology, pharmacology, and best practices of sedation and analgesia for the neurocritical care population. RECENT FINDINGS: In addition to established agents such as propofol and midazolam, dexmedetomidine and ketamine are two sedative agents that play an increasingly central role, as they have a favorable side effect profile on cerebral hemodynamics and rapid offset can facilitate repeated neurologic exams. Recent evidence suggests that dexmedetomidine is also an effective component when managing delirium. Combined analgo-sedation with low doses of short-acting opiates is a preferred sedation strategy to facilitate neurologic exams as well as patient-ventilator synchrony. Optimal care for patients in the neurocritical care population requires an adaptation of general ICU strategies that incorporates understanding of neurophysiology and the need for close neuromonitoring. Recent data continues to improve care tailored to this population.

Recommended Citation

Bauerschmidt, A., Al-Bermani, T., Ali, S., Bass, B., Dorilio, J., Rosenberg, J., & Al-Mufti, F. (2023). Modern Sedation and Analgesia Strategies in Neurocritical Care. Current Neurology and Neuroscience Reports, 23 (4), 149-158. https://doi.org/10.1007/s11910-023-01261-7