Sedation drips

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  • Sedation drips are indicated when a patient is on the ventilator
  • Proper sedation with reduce ICU days on the ventilator (Ely_Etal_2003).

Propofol

  • Generally a safe 1st line choice for rapid titration of sedation level.
  • General anesthetic and causes cardiorespiratory depression.
  • Good for short term sedation because it is fast on, fast off.
    • This makes it amenable to frequent neuro checks in TBI patients.
  • Serves as a source of calories.
  • Propofol infusion syndrome.
    • monitor triglycerides and CK levels
    • rhabdo
    • Tachyarrthmyias

Dexmedetomidine (Precedex)

  • Short acting A2 receptor agonist.
    • Bradycardia and hypotension.
  • Does not cause respiratory depression so good with patients trying to be extubated. Patients can be extubated with it still running.
  • Easy to arouse and alert, minimal amnesia.
  • May require other sedative, analgesic.

Midazolam (versed) drip

  • Short acting Benzodiazepine
  • Generally does not cause cardiac compromise.
  • Longeterm tx risks increased metabolite buildup and extended effects in patients with renal and liver dysfunction and the elderly.
    • This makes it not ideal for TBI patients as exams become difficult to obtain.
    • May extend duration on the ventilator.
  • Gtt 2-20 mg/hr

References

  1. https://www.youtube.com/watch?v=aWfzAdUnl8I
  2. 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. doi:10.1001/jama.289.22.2983