الفهرس 
Physiology of PainOnly 14 pages are availabe for public view
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Abstract
Pain is defined as a stressor for many patients in critical care settings and it is not unusual for the intensity of this pain to be described as moderate to severe. Although critical care clinicians strive to obtain the patients’ self-report of pain, many factors compromise the patients’ ability to communicate verbally including intubated patients.
Endotracheal intubation may create stress for critically ill.patients because of their inability to express anxiety and discomfort with an endotracheal tube in place. The inability to speak and the associated communication difficulties are a major source of distress for intubated patients.
It is reported that only 9% of intubated ICU patients were totally unable to communicate with health care professionals, and that 91% were able to communicate nonverbally by nodding,writing, or gestures.
Self-report is considered as the most valid measure of pain. But it has been proposed that behaviors associated with pain are valuable proxies for self-report and should be considered as alternative measures of pain in nonverbal patients.
While managing pain and anxiety in critical ill intubated patients, it is important to focus first on providing analgesia before anxiolysis. Patients who receive analgesics before anxiolysis consistently achieve comfort goals with less supplemental anxiolytic medications.
Opiates including morphine, fentanyl, hydromorphone, and remifentanil remain the drugs of choice for analgesia in intubated patients.
After appropriate analgesia, sedative medications should be given for anxiolysis and amnesia. Midazolam, lorazepam, and propofol are common sedative medications used in the critical ill intubated patient.