Sedation

In medicine, sedation refers to the dampening of functions of the central nervous system by means of a sedative ( sedative or sedative ). The term is used in particular in intensive care medicine or when using psychotropic drugs.

The transition from sedation to general anesthesia ( general anesthesia ) is fluid, with the latter the patient can no longer be awakened for the duration of the anesthesia. The term “ artificial coma ”, which is often used in the media, is incorrect, because “coma” primarily describes an uncontrolled loss of consciousness.

term

The term sedation is also rarely used as a synonym for sedation (from the Latin sedare for "to calm down"). If a pain reliever ( analgesic ) is administered at the same time, one speaks of analgesic sedation .

In the palliative care a so-called can terminal sedation are used.

application

Restlessness is a common symptom of physical and mental illness . Restlessness can often be alleviated by the targeted administration of sedatives. Sedatives are generally sleep-promoting and, in higher doses, lead to the elimination of conscious perception , ideally a distancing from various fears . A targeted treatment of anxiety, on the other hand, is called anxiolysis (see tranquilizers ).

Before major diagnostic or therapeutic interventions, sedation is indicated in order to reduce the stress burden for the patient and still ensure his responsiveness and thus enable the best possible cooperation with the examiner or therapist. Appropriate precautionary measures must be taken to protect the patient in order to minimize the risk of possible complications, in particular an unintentional loss of consciousness, impairment or even elimination of protective reflexes (such as the cough reflex ) or circulatory or respiratory depression.

If deeper sedation is necessary or if a transition to anesthesia is to be expected, the patient needs appropriate intensive monitoring and support, so that an anesthesiologist must be called in, who, in addition to the appropriate sedative, often also administers an analgesic if necessary . Supervised sedation with analgesia is known as "analgesic sedation".

In the context of intensive care medicine , the administration of sedatives is usually necessary in ventilated patients, since ventilation without such medication is often not tolerated, especially in non- tracheostomized patients. The desired depth of sedation is determined by the doctor using the Richmond Agitation Sedation Scale (formerly the Ramsay scale ), regularly checked and adjusted if necessary. One proceeds according to the guidelines drawn up by the DGAI .

Substances

• Benzodiazepines such as Diazepam , Midazolam , Temazepam , Nitrazepam , Flunitrazepam
• Antidepressants such as trazodone , doxepin , trimipramine , amitriptyline , mirtazapine , mianserin , agomelatine
• Narcotics and hypnotics such as thiopental , etomidate , ketamine, and propofol
• Barbiturates such as phenobarbital are rarely used as sedatives these days; rather, they serve as anti-epileptic drugs .
• Neuroleptics such as phenothiazines (e.g. promethazine ), thioxanthenes such as chlorprothixen , butyrophenones such as haloperidol , prothipendyl
• Opioids like fentanyl , morphine, and sufentanil
• Today, alpha-2 adrenoceptor agonists, such as clonidine , and in veterinary medicine xylazine , dexmedetomidine and medetomidine are increasingly used
• Valnoctamide
• First generation H1 antihistamines such as hydroxyzine , diphenhydramine and doxylamine
• Herbal sedatives ( phytotherapy ): often valerian , lemon balm , hops and passion flower , linarin , real St. John's wort as well as combinations of these, more rarely e.g. B. Kava

Problems

Many sedatives lead to tolerance (habituation), so that the dose must be increased or another sedative must be used in the course of use in order to maintain the desired depth of sedation. Many sedatives therefore have a potential for abuse in long-term use (does not apply to neuroleptics), which can lead to addiction .

The advantage of sedatives described above, the elimination of consciousness, also has a negative effect on the organism. If necessary, the reduction of the respiratory drive must be counteracted with ventilation and the circulation must be maintained with catecholamines .

There are also paradoxical reactions: the drug does not achieve the desired effect, the patient becomes restless and can no longer be controlled.

Web links

Wiktionary: tranquilizers  - explanations of meanings, word origins, synonyms, translations

Wiktionary: sedate  - explanations of meanings, word origins, synonyms, translations

literature

• S. Fitzal: drug therapy, inhalation therapy. In: J. Kilian, H. Benzer, FW Ahnefeld (ed.): Basic principles of ventilation. Springer, Berlin a. a. 1991, ISBN 3-540-53078-9 , 2nd, unaltered edition, ibid 1994, ISBN 3-540-57904-4 , pp. 290-304; here: pp. 290–295 ( sedation / analgesia and relaxation ).
• WE Müller: Sedatives as an example for the peculiarities of psychopharmacotherapy in old age. In: Hans Förstl (Ed.): Textbook Gerontopsychiatrie. Thieme, Stuttgart 2002, pp. 220-226.

Individual evidence

1. ↑ Guideline on sedation and analgesia (analgesia sedation) of patients by non-anesthetists , German Society for Anesthesiology and Intensive Care Medicine, Anaesth Intensivmed 2002; 10: 639-641.
2. ↑ Analgesia, sedation and delirium management in intensive care medicine - long version , guidelines of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) and the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) (PDF; 1.7 MB).
3. ↑ S3- guideline for analgesia, sedation and delirium management in intensive care medicine of the DGAI and DIVI . In: AWMF online (as of 12/2009).

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