My topics and questions are only in the early stages and haphazard. It will be a literature review. So far I am thinking of the effects of sedation breaks in adult ICU patients. Early mobilisation, the psychology effects on long term ICU patients, Are the medical profession overdosing patients who are sedated with opioids/ maybe over use of opioids in the sedated patients. Trying to get an idea of where to go what topic Il get the most information on and develop a question.
Balancing patients sedation is always interesting topic for research. The same patient will need variable doses at different times in the same day. Incorporating automated system (like AI) to monitor and adjust sedation in ICU patients can offer the perfect balance for the adequate amount to Rx.
Siobha,
I am not familiar with “grad dip”. Is this a research project or an evidence based practice project?
It is quite amazing to me the carefree attitude when sedating ICU patients. Fentanyl infusions are ubiquitous, used to “treat pain” and sedate ventilated patients. There are several disadvantages to this practice:
1: weening a narcotized Patients is difficult. Hypercarbia and acidosis.
2: Large doses of opioids induce hepatic metabolism, change mu receptors at the second order neurons into excitatory receptors instead of inhibitory. Read opioid induced hyperalgesia (OIH). Making pain worse, not better.
3: Staff “feel” as if they are addressing acute and chronic pain and arenot exploring better alternatives.
4: It is difficult to “control“ access when bags of opioids are in nearly every room. This puts the staff at risk for diversion and abuse.
I could go on and on but I’ll wait to hear your response.
Regards,
Christopher
To Dr. Mohamad-Hani Temsah Sir, just for my ignorance... what is AI?
To Dr. Christopher A Smith Sir, you are so antagonist to Fentanyl...!!! But, at the end of the day, we all return and depend on those syringes of FentaMidaz. Again, your points are quite valid and valuable. Regards- Rabiul.
To Dr. Rabaul Alam, I trained in the early 90’s and was taught that fentanyl was cardioprotective and the foundation of EVERY anesthetic. It was mostly just marketing and not evidence based. The current lawsuits in the US have uncovered the lies and misrepresentation related to opioids. Opioids have there place but are not the foundation we were led to believe. If they were, we wouldn’t look to limit their use in enhansed recovery after surgery (ERAS) protocols. Our ICU colleagues need to re-examin their practices of relying on fentanyl to sedate their patients.
Respectively,
Christopher
Christopher A Smith Sir, your answer regarding opioids, specially fentanyl, is really eyeopener to me. Thank you very much, indeed. Rabiul.
What “speaks” to you? All of your topics certainly have merit. One Way to look at this is to form a question and then ask “so what?” What is the benefit to looking at the topic? How will looking at the topic improve a process or an outcome for a patient? Sedation and the benefits if early mobility is something that I would like to see explored further. Good luck!
You can try to compare ICU sedation between dexmedetomidine and fentanyl (or probably better remifentanil) and patients' mobility, awakeness, cooperability with ICU staff...Might be interesting...
Nikola Bradic, I like the dexmedetomidine although I believe that remifentanil is actually a poor choice:
1. Cost (most expensive choice in the US)
2. Higher adverse reactions
3. Tolerance quicker
4. Hyperalgesia more common in remi.
Article Rapid Development of Tolerance to Analgesia During Remifenta...
https://hub.hku.hk/bitstream/10722/44556/1/121228.pdf?accept=1
If study is planned... a new intervention compared to usual care is a better choice. There is the option for a three group study.
IMHO, warmest regards,
Christopher
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