Chapter 18 - Sedation in the intensive care setting

Summary

This chapter emphasizes thorough patient evaluation to identify appropriate intensive care unit (ICU) sedation candidates, and reviews common indications for ICU sedation administration. It examines the risks inherent in under- and oversedation, and reviews the basic pharmacology and administration techniques of commonly utilized ICU sedatives and analgesics. Specific sedatives and analgesics have known pharmacologic effects on contractility, vascular tone, and sympathetic-parasympathetic balance. Certain sedative medications rely upon hepatic inactivation or have active metabolites that require renal elimination. The chapter describes the sedation scales to guide ongoing sedation administration and minimize the chance of under- or oversedation. Cerebral function monitors (CFMs) are primarily utilized in the operating room to monitor anesthesia levels and minimize patient recall of unpleasant intraoperative events. They have yet to be widely accepted for ICU sedation monitoring, and little correlation exists between sedation scale and bispectral index (BIS) readings.