ICU sedation


Propofol

  • analgesics (pain) vs anxiolytics (sedation)
  • IV push vs drip
  • RASS goal? Stay in 0, -1, -2

Precedex

Anxiolytics

PushDripDosingIndicationCaution
Propofolxx0.5 mcg/kg/min
0-100mg
- drug of choice
- fat soluble
- short half life
-hypotension>bradycardia
- propofol infusion syndrome
- hyperlipidemia
Versed
midazolam
xxxx0.04 mg/kg/hr- sedation
- ETOH withdrawal on vent
- seizures
- hypotension
- delirium
- accumulation in fatty tissues
- liver renal dosing
Ativan
Lorazepam
xx0.04 mg/kg/hr
1-4mg IV Q3 PRN
- ETOH withdrawal
- seizures
- CIWA
- same as Versed
- propylene glycol toxicity (no drip)
Halodolxx5-10mg IV Q4-6 PRN- delirium
- agitation
- long QT
- EPS
Precedex
Dexmedotramidin
xx0-0.7 mcg/kg/hr- delirium
- agitation
- weaning off vent
- bradycardia>hypotension
- cost
Ketaminexxonly status epilepticus

Analgesics

PushDripDosingIndicationCaution
Fentanylxxxx25-100 IV PRN Q2
0.1-4 mcg/kg/hr
- drug of choice
- short 1/2 life
- BP neutral
safe
short 1/2 life
Dilaudidxxx0.5-4 mg Q3- opioid experienced
- sickle cell
hypotension
Morphinexx5-10 mg IV Q3- rarely in ICU
- terminal weaning
- air hunger suppression
hypotension
histamine release
itching
renal failure