04 Sedation

ICU Sedation

  • analgesics (pain) vs anxiolytics (sedation)

  • IV push vs drip

  • RASS goal? Stay in 0, -1, -2

Anxiolytics

Push

Drip

Dosing

Indication

Caution

Propofol

xx

0.5 mcg/kg/min 0-100mg

- drug of choice - fat soluble - short half life

-hypotension>bradycardia - propofol infusion syndrome - hyperlipidemia

Versed midazolam

xx

xx

0.04 mg/kg/hr

- sedation - ETOH withdrawal on vent - seizures

- hypotension - delirium - accumulation in fatty tissues - liver renal dosing

Ativan Lorazepam

xx

0.04 mg/kg/hr 1-4mg IV Q3 PRN

- ETOH withdrawal - seizures - CIWA

- same as Versed - propylene glycol toxicity (no drip)

Halodol

xx

5-10mg IV Q4-6 PRN

- delirium - agitation

- long QT - EPS

Precedex Dexmedotramidin

xx

0-0.7 mcg/kg/hr

- delirium - agitation - weaning off vent

- bradycardia>hypotension - cost

Ketamine

xx

only status epilepticus

Analgesics

Push

Drip

Dosing

Indication

Caution

Fentanyl

xx

xx

25-100 IV PRN Q2 0.1-4 mcg/kg/hr

- drug of choice - short 1/2 life - BP neutral

safe short 1/2 life

Dilaudid

xx

x

0.5-4 mg Q3

- opioid experienced - sickle cell

hypotension

Morphine

xx

5-10 mg IV Q3

- rarely in ICU - terminal weaning - air hunger suppression

hypotension histamine release itching renal failure

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