De Pinto Mario, Jelacic Jill, Edwards William T
Department of Anesthesiology, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
J Opioid Manag. 2008 Jan-Feb;4(1):54-6. doi: 10.5055/jom.2008.0009.
Management of pain in critically ill patients can be very difficult. In the attempt to provide comfort with adequate levels of opioids and sedatives, respiratory depression and cardiovascular instability may become difficult to control in patients with labile hemodynamics and poor cardiopulmonary reserve. The use of medications like ketamine, an anesthetic agent that in subanesthetic doses has been reported to be effective in preventing opioid-induced tolerance and to have analgesic properties, may be of help, especially in patients who develop tolerance, leading to rapidly escalating doses of opioids and sedatives. The case report presented here shows how a very low dose of ketamine can be helpful for the management of pain and sedation in critically ill patients, especially when they are ready to be weaned from mechanical ventilation, and very high doses of opiods and sedatives do not permit it.
重症患者的疼痛管理可能非常困难。在试图通过使用适当剂量的阿片类药物和镇静剂来提供舒适感时，对于血流动力学不稳定且心肺储备功能差的患者，呼吸抑制和心血管不稳定可能难以控制。使用氯胺酮等药物可能会有所帮助，氯胺酮是一种麻醉剂，据报道在亚麻醉剂量下可有效预防阿片类药物引起的耐受性并具有镇痛特性，尤其是对于那些产生耐受性、导致阿片类药物和镇静剂剂量迅速增加的患者。此处呈现的病例报告显示了极低剂量的氯胺酮如何有助于重症患者的疼痛和镇静管理，特别是当他们准备撤机时，而高剂量的阿片类药物和镇静剂却无法实现这一点。
