1. Epidural analgesia – Epidural administration involves injection of an anesthetic agent into the epidural space around the spinal cord. This route of injection blocks pain sensation by inhibiting nerve signal transmission in the fibers of the spinal cord.
2. Opioids – Opioids selectively work on neurons that transmit and modulate painful stimuli, leaving certain body functions such as sensation and motor function intact. While opioids are effective at controlling pain, dependence and withdrawal effects can occur with prolonged continuous infusion. The most common used opioids in mechanically-ventilated patients are fentanyl and remifentanil.
3. Morphine – Morphine is the oldest opioid used for relief of moderate to severe pain. This medication works by acting on the brain and nervous system to reduce perception of pain. One study even shows that continuous infusion of morphine in mechanically-ventilated patients reduces the stress response and promotes the human-machine coordination.
4. Benzodiazepines – Benzodiazepines belong to a class of anti-anxiety drugs. They work by enhancing the effect of the neurotransmitter (brain chemical) gamma-Aminobutyric acid (GABA), which in turn stimulates receptors that inhibit or calm down brain activity. Midazolam and lorazepam are the most commonly used benzodiazepines in mechanically-ventilated patients.
5. Propofol – Propofol is a short-acting sedative-hypnotic agent that causes a decreased level of consciousness and lack of memory for events. Just like benzodiazepines, this medication works by enhancing the effect of GABA receptor.
6. Dexmedetomidine – Dexmedetomidine is an anti-anxiety drug, sedative, and pain medication. This drug works by activating brain and spinal receptors which in turn relaxes the nerves, causes sedation, and reduces pain sensation. Unlike other sedatives, dexmedetomidine has the ability to provide sedation without risk of respiratory depression. However, it is not recommended for long-term deep sedation.
Evidence suggests that the use of dexmedetomidine for sedation in mechanically ventilated patients can help reduce time to extubation and length of time in the intensive care unit (ICU).
7. Bronchodilators – Of course, as a Respiratory Therapist, you will most certainly administer bronchodilators to patients receiving Mechanical Ventilation. These can be given as a solution via nebulizer, or as an MDI (metered-dose inhaler). Both can be administered directly into the patient’s ventilator circuit.