Sedative Agents in Critical Care

Sedative Agents Overview

• Common treatments for anxiety in critical care include benzodiazepines, propofol, and dexmedetomidine.
• Patients in critical care may experience both pain and anxiety, potentially with psychotic features such as delirium.

Benzodiazepines

• Classified as sedatives and hypnotics but lack analgesic properties.
• Elderly patients or those with renal or hepatic insufficiency may have slower benzodiazepine clearance, leading to prolonged effects.
• Continuous infusions require monitoring to prevent over-sedation.

Propofol

• An intravenous general anesthetic used for sedation; requires special access for continuous infusion to prevent infection.
• Possesses rapid onset and short duration of action.
• No analgesic properties; potential adverse effects include hypotension, bradycardia, and increased triglyceride levels.
• High-dose infusions can lead to metabolic acidosis or dysrhythmias, and the maximum hanging time is 12 hours.
• Should be considered a caloric source when administered due to its lipid content.

Neuromuscular Blockade (NMB) Agents

• NMB agents do not provide sedative or analgesic effects; muscle relaxants facilitate intubation, ventilation, and bedside procedures.
• Patients on NMB agents must also be sedated, often starting continuous sedative infusions prior to NMB administration.
• Pain or anxiety during NMB can result in elevated heart rate and blood pressure responses.
• Patients lose voluntary muscle movement, communication, and the ability to breathe independently when on NMB.