Episode 52. Just A Diet Prop for Me: Post-Intubation Analgesia and Sedation

Introduction

• Rapid sequence intubation (RSI) is a process whereby an induction agent and a neuromuscular blocking agent are given in rapid succession to facilitate endotracheal intubation
• The immediate post intubation period in the ED is a critical time for continued patient stabilization.
• While physical adjuncts like securing the tube, in line suctioning, and elevating the head of the bed are part of general post intubation management, post intubation analgesia and sedation is a key component to remember.
• Depending on the paralytic used, clinicians can be eased into the assumption that the patient is tolerating the ventilator and not in need of sedation or analgesia
• Administering analgesia and sedation is key to preventing patient awareness during paralysis and preventing PTSD

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Script for the Episode

The Pharm So Hard Podcast

Episode 52: Just a Prop For Me Please: Post-Intubation

Guest Speaker: Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

Host: Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

1. Theme Music Intro
2. Brief intro of host
3. Intro of the Guest
4. Speaking Points
   1. Why this topic important?
   2. Briefly Describe the intubation process
   3. What are some common causes of Pain in the ED
      1. Acute pain can invoke a stress response, resulting in a hypercatabolic state, decreased tissue perfusion, and impaired wound healing. Uncontrolled pain decreases a patient’s immune response to infection by suppressing natural killer cell activity and neutrophil function.
   4. Are there any short and long term consequences of pain in critically ill patients?
      1. Acute pain can invoke a stress response, resulting in a hypercatabolic state, decreased tissue perfusion, and impaired wound healing. Uncontrolled pain decreases a patient’s immune response to infection by suppressing natural killer cell activity and neutrophil function.
         1. a traumatic injury.
         2. a. Health-related quality of life is decreased in up to 20% of patients.
         3. b. Chronic pain is reported in up to 40% of patients.
         4. c. Posttraumatic stress disorder is reported in 5%–20% of patients.

5. What are the agents you use for analgesia for post-intubation analgesia
   1. Fentanyl
      1. Dose
      2. PK/PD
   2. Morphine
      1. Dose
      2. PK/PD
   3. Hydromorphone
      1. Dose
      2. PK/PD

4. Ketamine
   1. Dose
   2. PK/PD

6. Are there any data to support using bolus therapy versus infusions?
7. How do you monitor Sedation in intubated patients?
8. Is there a level of sedation that is preferred? Deep vs Light?
9. What is analgosedation and how do you do it appropriately?
10. What are the most common sedation agents
    1. Propofol
    2. Midazolam
    3. Dexmedetomidine
11. Any Literature of the value of a pharmacist in post-intubation sedation?

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