Sedation during and after CPR-efforts: is it worth a guideline?

Cardiac arrest, an extreme example of acute perturbation of homeostasis, leads to a maximal stimulation of the neuroendocrine axis with the highest endogenously released epinephrine and norepinephrine concentrations found in man [ 11. Although consciousness is lost within 10 s after the onset of circulatory arrest, the stress-response might be accelerated not only by painful resuscitative acts such as cardiac massage, endotracheal intubation and early electrical defibrillation, but also by the administration of vasopressors. This physiological response benefits the body on a short-term basis when the injury is minor, but a profound and prolonged reaction may have devastating consequences in patients with diminished pulmonary or cardiac reserve. Structural abnormalities of intracardiac nerves, due to coronary artery disease, may contribute to the reduction of the threshold for malignant ventricular arrhythmias. Local areas of myocardial denervation may become supersensitive to catecholamioes [2]. Therefore, it is conceivable that blunting stress responses in patients with coronary artery disease might counteract the initiation or recurrence of ventricular and supraventricular arrhythmias. Furthermore, the diversion of bloodflow from kidney, liver and gut dur