Sedation and Analgesia for Patients with Acute Brain Injury

Neuro-critical care doctors should be familiar with the topics of sedation and analgesia for patients with acute brain injury (ABI) in the intensive care unit (ICU). Patients with elevated intracranial pressure (ICP) should be managed by intubation and mechanical ventilation with sedation of barbiturates, propofol, and midazolam. When propofol is used, special attention should be given to propofol infusion syndrome. To regulate sympathetic nerve activity and avoid hypertension, the rationale is to use opioids for ABI patients. Treatment with sedation interruption strategy should be avoided in all patients at risk for ICP elevation, who are undergoing TTM and treatment of refractory status epilepticus. Administration of ketamine has been associated with a reduction in the progress of spreading depression. Use of ketamine and dexmedetomidine for ABI patients may be optimized in selected cases.