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Intravenous Sedatives and Analgesics

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Book cover Critical Care Sedation

Abstract

Critically ill patients often require sedative and analgesic drugs to optimize patient comfort, facilitate patient-ventilator synchrony, and allow tolerance to procedures. The level of sedation can change during a patient’s stay and an optimal degree of sedation is necessary to avoid the risk of oversedation and to reduce the risk of delirium, the length of mechanical ventilation, and the length of stay in the ICU.

The ideal analgesic or sedative agent is characterized by many properties, for example: (a) a short onset time of action, (b) easy to administer and to titrate in order to produce effective sedation, (c) reproducible in dosage to obtain a similar clinical goal in a large and varied population, (d) predictable with regard to clinical and side effects, (e) free from severe adverse effects on hemodynamic conditions or respiratory function. Furthermore, drug metabolism should not be affected by impaired organ function, drug interactions or augmented volume of distribution, and it should not be protein bound. The offset time should be short enough to rapidly reverse sedation. Several new drugs have been developed, some of very closely meet these ideal features. The aim of this chapter is to review the pharmacology, in terms of pharmacokinetic (PK), pharmacodynamic (PD), and pharmacogenetic factors, of most commonly used sedatives (propofol, benzodiazepines, α2-agonists) and opioid analgesics. In addition, important issues for daily clinical analgo-sedation practice aimed at improving patients’ comfort, treatment outcome, and safety are specifically addressed.

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    Francesco Barbani M.D., Elena Angeli M.D. & A. Raffaele De Gaudio M.D.

  2. Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Francesco Barbani M.D., Elena Angeli M.D. & A. Raffaele De Gaudio M.D.

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Barbani, F., Angeli, E., De Gaudio, A.R. (2018). Intravenous Sedatives and Analgesics. In: De Gaudio, A., Romagnoli, S. (eds) Critical Care Sedation. Springer, Cham. https://doi.org/10.1007/978-3-319-59312-8_6

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