Jun 27, 2022
Contributor: Peter Bakes, MD
- When intubating a patient, it is important to
consider what medications will be used for post-intubation sedation
- The common non-benzodiazepine sedating
medications are propofol, precedex, and ketamine
- Propofol is frequently used in the emergency
department, and it lowers ICP and MAP making it the preferred
sedative for patients with intracranial bleeds
- Precedex is a milder sedative used in the ICU
because it decreases time to extubation and reduces the risk of
complications associated with long term intubation
- Ketamine should be used in hypotensive patients
because it does not lower blood pressure, and its bronchodilatory
effect is beneficial for asthmatic patients
- Versed and ativan are the most commonly
encountered benzodiazepine sedatives, but they are infrequently
used because they increase the risk of delirium and delay
- Benzodiazepines are useful for sedation in
patients with delirium tremens
- For post intubation analgesia, fentanyl is the
drug of choice since it has a lower risk of hypotension than is
seen in other narcotics
- In the emergency department, intubated and
sedated patients should initially be sedated to a RASS of -2 while
obtaining imaging, but aim for a RASS of -1 after to decrease side
effects and promote earlier extubation
Ely EW, Truman B, Shintani A, et
al. Monitoring sedation status over time in ICU patients:
reliability and validity of the Richmond Agitation-Sedation Scale
(RASS). JAMA. 2003;289(22):2983-2991.
Garner O, Ramey JS, Hanania NA.
Management of Life-Threatening Asthma: Severe Asthma Series. Chest.
Keating GM. Dexmedetomidine: A
Review of Its Use for Sedation in the Intensive Care Setting.
McKeage K, Perry CM. Propofol: a
review of its use in intensive care sedation of adults. CNS Drugs.
Ramos-Matos CF, Bistas KG,
Lopez-Ojeda W. Fentanyl. In: StatPearls. Treasure Island (FL): StatPearls Publishing.
Copyright © 2022, StatPearls Publishing LLC.; 2022.
Summarized by Mark O’Brien,
MS4 | Edited by John Spartz, MD & Erik Verzemnieks,
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