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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Optimizing sedation in the ICU: the eCASH concept


Deep sedation is known to be associated with poor long-term outcomes in critically ill patients, including cognitive and psychological complications and increased mortality. Yet many patients still receive high levels of sedation, particularly during the early days of their intensive care unit (ICU) stay. The eCASH (early Comfort using Analgesia, minimal Sedatives and maximal Humane care) concept is a three-pronged approach to minimize sedation in ICU patients by ensuring adequate and timely analgesia is received; patient-centred care is encouraged, including communication aids, noise reduction to facilitate good sleep patterns, early mobilization, and family involvement; and, when needed, sedation is targeted to individual needs and regularly reassessed, with patients kept calm, comfortable and able to cooperate.

Key words: analgesia, communication, sleep, mobilization

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Diclofenac premedication, as the effect of preventive anelgesia after post thoracotomy/thoracoscopy pain, as well as the changes of the lung function test values


Preventive analgesia is defined as administration of analgetics or nerve blockade before the surgical procedure. As a result of the preventive antinociceptive treatment, the quantity of post-operative medications can be decreased, the analgesia has less complications and the patients are more satisfied [1,2].

In our study we intend to examine the preventive analgetic effect a single oral dose of diclofenac.

The hypothesis of the study is that preventive analgesia by single dose of diclofenac results in 25% decrease of the postoperative VAS scores as compared to the control group.

Key words: preventive, pain, analgesia

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