I recently had a Facebook conversation with a colleague of mine, emergency medicine registrar Matthew Oliver about post intubation sedation with propofol and I thought it was was worth sharing the main points of it. Mat brought to my attention a side-splitting rant by critical care superhero Cliff Reid on ercast about propofol use in the resus room, and it got me thinking about my own practice regarding inducation and sedation in the critically ill.
Before I put a post together though, I thought I’d conduct a little survey of the online critical care community to see what people are doing around the world regarding induction of anaesthesia and maintenance of sedation in critically ill patients. So please answer the survey questions and I’ll use the results in my upcoming post on sedation in the critically ill. The polls are only referring to sedatives. I’m assuming that you’re using a muscle relaxant as I think that intubation facilitated by sedation borders on negligence (a post for another day perhaps).
After you’ve answered the poll, you should check out this link to the BMJ from 1944. That’s right 1944. It gives an amazing insight into care of critically ill trauma patients during WWII. Most of the patients died, and the authors recommended anaesthesia with cyclopropane, which I’m not sure I would. But they do make this very insightful comment right at the end of the paper:
“The chief factors in anaesthetizing shocked patients seem, therefore, to be, first, the use of a minimal- amount of anaesthetic – and it is often surprising how little these patients require; secondly, the choice of an anaesthetic which stimulates rather than depresses the cardiovascular system; and, thirdly, an adequate amount of oxygen.”
Anyway, on to the poll. Please leave any comments below if there’s a drug that you think is missing!