Analgesia, sedation and anaesthesia in emergency medicine

Skilful analgesia is self-explaining and must not be justified. Unlike this, general anaesthesia is not an end in itself, a fact which is emphasized by the often unfavourable preclinical conditions of the emergency medical system. Furthermore, the decision for performing preclinical generral anaesthesia depends in part on the professional qualities of the emergency physician. Analgesic and anaesthetic drugs should be administratered through a secure intravascular line. In contrast to the rapid sequence induction (RSI) of general anaesthesia, analgesic drugs should be titrated. The patient is monitored by an attentive physician and adequate technical equipment. Metamizole is used for the treatment of minor and medium pain, whereas morphine is indicated in major pain. Fentanyl is particularly used is total intravenous anaesthesia (TIVA) with controlled ventilation. (S)-ketamine is indicated for analgesia, analgosedation and anaesthesia in trauma patients and in special internal cases.. Midazolam is used for sedation, and, in combination with (S)-ketamine or fentanyl, for TIVA. Etomidate is especially useful for RSI of emergency patients with haemodynamic stability. As relaxants, suxamethonium for RSI and, for longer muscle relaxation, the logistically favourable vecuronium are established. Butylscopolamine is used in colic pain alone or in combination with analgesic drugs. Ha loperidol is indicated in acute psychotic syndromes as well as psychomotoric and alcohol dependent excitation. Profound pharmacological and practical knowledge is necessary, and limiting oneself to a few drugs will improve one's personal experience.