Analgesia-Sedation of Cases with Associated Craniocerebral Trauma: A Dynamic Scale for Estimation of Its Efficacy

V.K. Shumovskiy, M.V. Alekseev, G.V. Alekseeva, I.V. Molchanov, O.N. Dreval, V.A. Lazarev

Faculty of Neurosurgery and Faculty of Anesthesiology and Reanimatology the Russian Medical Academy of Postgraduate Education, Moscow, Russia

 

Adequate analgesia-sedation is a necessary chain in treatment of associated craniocerebral trauma. Nevertheless, today there are no objective complex criteria of its efficacy.

Proposed scales are inadequate in unconscious cases and EEG monitoring is not always available. We examined 52 cases with severe associated craniocerebral trauma (the Glasgow Coma Scale - <8; APACHE.II - >20, ISS - >25).

The results allowed to elaborate a scale for estimation of analgesia-sedation efficacy with taking into account an unconscious state of a patient (scoring):

1. A Vegetative State

2. A Degree of Patient’s Adaptation to a Respirator

3. A Motor Response (A score, based on estimation of upper extremities and shoulder girdle)

A total score is a sum of all scores, obtained at every point. Its maximum and minimum values are 16 and 5, respectively. Results are interpreted in the following way: a score of 11-16 – insufficient analgesia-sedation, a score of 7-10 – optimum analgesia-sedation, a score of less than 7 – excessive deep analgesia-sedation.

This scale allows to exclude any verbal communication with a patient.