Intravenous analgesia

Intravenous analgesics available to intensivists include opioids, ketamine, and the injectable nonsteroidal anti-inflammatory agent ketorolac. Practitioners are updated on a potentially protective role for opioids in myocardial ischemia, on recent studies of opioid-induced respiratory depression, and on a newly investigated opioid antagonist and its potential role in the prevention of paralytic ileus. The suitability of ketamine as an analgesic agent in critically ill patients is discussed. The results of its use by infusion and in patients with hemodynamic and respiratory instability are presented. An emerging body of literature has increased our understanding of the indications for ketorolac in the acute setting. Increased evidence has emerged for the ability of ketorolac to induce early-onset gastrotoxicity and renal failure. Additional information, on the other hand, supports its cost-effective use following certain major surgeries.