The Multimodal Approach to Opioid Pain

I know that opioids are the staple analgesic in critically ill patients, absolutely. And it's been interesting for me to observe over the years, the sling of the pendulum from a time where people got intubated and sedated but never had any analgesics. I see these patients who would be receiving extraordinarily high doses of opioids for extended periods of time. The example I often give is say an elderly frail woman who has COPD, and is getting 250 micrograms per hour of fentanyl. That's probably enough to sink a, you know, a battleship if you will. Ketamine has become a very interesting drug that I've started to see used more. We always feared