Adequate sedation is essential in all patients with elevated ICP in order to minimize agitation and movement, and to improve tolerance of the endotracheal tube. Coughing or gagging on the tracheal tube or during tracheobronchial suction can cause rapid, extreme elevations in ICP. Neuromuscular paralysis effectively prevents this but at the expense of eliminating neurological examination as a monitor of the patient's condition. In addition, prolonged pharmacological blockade may result in the development of myopathy and persistent paralysis. Moreover, neuromuscular blocking agents (NMBs) should only be used in patients who are adequately sedated in order to avoid paralysis in an awake patient. Intermittent dosing and periodic discontinuation, coupled with careful monitoring of the degree of neuromuscular blockade, should allow regular neurological assessment.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.