====== Sedative for traumatic brain injury ======

[[Analgesic]]s and [[sedative]]s are frequently used in the treatment of acute [[brain injury]] and subsequent [[brain swelling]]. Most agents act on specific receptors to modulate neuronal activity, which is normally involved in feedback loops that direct system building and maintenance. 
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The routine use of sedatives and paralytics in [[neurotrauma]] patients may lead to a higher incidence
of [[pneumonia]], longer ICU stays, and possibly [[sepsis]]
((Hsiang JK, Chesnut RM, Crisp CD, et al. Early,
Routine Paralysis for Intracranial Pressure Control
in Severe Head Injury: Is It Necessary? Crit Care
Med. 1994; 22:1471–1476)).

These agents also impair the neurologic assessment
((The Brain Trauma Foundation. The American
Association of Neurological Surgeons. The Joint
Section on Neurotrauma and Critical Care. Initial
management. J Neurotrauma. 2000; 17:463–469))
((Marion DW, Carlier PM. Problems with Initial
Glasgow Coma Scale Assessment Caused by
Prehospital Treatment of Patients with Head
Injuries: Results of a National Survey. J Trauma.
1994; 36:89–95)). Use should, therefore, be reserved for cases with clinical evidence of intracranial hypertension, for intubation, or where use is necessary for transport or to permit
evaluation of the patient (e.g. to get a combative patient to hold still for a CT scan)
((Bullock R, Chesnut RM, Clifton G, et al. Guidelines
for the Management of Severe Head Injury. 1995)).
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Level III: sedation and neuromuscular blockade (NMB) can be helpful for transporting the head-injured patient, but they interfere with the neuro exam

Level III: N M B should be used when sedation alone is inadequate 

The routine use of sedatives and paralytics in neurotrauma patients may lead to a higher incidence of pneumonia, longer ICU stays, and possibly sepsis.

These agents also impair neurologic assessment.

Use should, therefore, be reserved for cases with clinical evidence of [[intracranial hypertension]], for intubation, or where use is necessary for transport or to permit evaluation of the patient (e.g. to get a combative patient to hold still for a CT scan).

===== References =====