Sedation and Analgesia: Optimizing Care for the Critically Ill

Authors: Mark H , Nguyen HM and Tanios M

DOI: 10.23880/accmj-16000179

Volume 5, Issue 2

Abstract

Pharmacotherapy for sedation is an essential component of the management of critically ill patients in the intensive care unit (ICU). Sedation agents, such as benzodiazepines and propofol, can target light or deep sedation levels and eliminate the patient’s awareness of the environment during mechanical ventilation (MV). Those agents can also facilitate procedures such as tracheal intubation, prone position, wound care, or minor surgical procedures. Historically, benzodiazepines (e.g., midazolam, lorazepam) and propofol have been the medications of choice to facilitate mechanical ventilation (MV) in North America. In the past decade, dexmedetomidine (DEX) was introduced for procedural sedation and sedation during MV. DEX is a highly selective alfa2-receptor agonist with sedative and mild analgesic/ opioid-sparing properties. Its pharmacology is distinct from propofol and benzodiazepines in that its mechanism of action is not mediated by agonism or binding to the gammaaminobutyric acid receptors; thus, reducing respiratory depression risk. This property made DEX the preferred agent when light sedation and rapid extubation are planned. DEX is not recommended when deep sedation is required or for managing conditions such as status epilepticus or when neuromuscular blocking agents are used. 

Keywords:

View PDF