Payen J-F, Francony G, Canet C, Coppo F, Fauvage B
Service de réanimation neurochirurgicale, pôle d'anesthésie-réanimation, hôpital Michallon, Grenoble cedex 09, France.
Ann Fr Anesth Reanim. 2009 Dec;28(12):1015-9. doi: 10.1016/j.annfar.2009.10.003.
The objectives for using sedation in neurointensive care unit (neuroICU) are somewhat different from those used for patients without severe brain injuries. One goal is to clinically reassess the neurological function following the initial brain insult in order to define subsequent strategies for diagnosis and treatment. Another goal is to prevent severely injured brain from additional aggravation of cerebral blood perfusion and intracranial pressure. Depending on these situations is the choice of sedatives and analgesics: short-term agents, e.g., remifentanil, if a timely neurological reassessment is required, long-term agents, e.g., midazolam and sufentanil, as part of the treatment for elevated intracranial pressure. In that situation, a multimodal monitoring is needed to overcome the lack of clinical monitoring, including repeated measurements of intracranial pressure, blood flow velocities (transcranial Doppler), cerebral oxygenation (brain tissue oxygen tension), and brain imaging. The ultimate stop of neurosedation can distinguish between no consciousness and an alteration of arousing in brain-injured patients. During this period, an elevation of intracranial pressure is usual, and should not always result in reintroducing the neurosedation.
在神经重症监护病房（neuroICU）使用镇静的目的与用于无严重脑损伤患者的目的有所不同。一个目标是在最初的脑损伤后对神经功能进行临床重新评估，以便确定后续的诊断和治疗策略。另一个目标是防止严重受伤的大脑出现脑血流灌注和颅内压的进一步加重。根据这些情况来选择镇静剂和镇痛药：如果需要及时进行神经功能重新评估，可选择短效药物，如瑞芬太尼；作为颅内压升高治疗的一部分，可选择长效药物，如咪达唑仑和舒芬太尼。在这种情况下，需要进行多模式监测以克服临床监测的不足，包括重复测量颅内压、血流速度（经颅多普勒）、脑氧合（脑组织氧分压）和脑成像。神经镇静的最终停用可以区分脑损伤患者是无意识还是唤醒改变。在此期间，颅内压升高是常见的，并不总是需要重新进行神经镇静。
