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ICU Sedative and Analgesic Guide

This document provides information on common sedative and analgesic medications used in the ICU. For sedatives, it lists lorazepam, midazolam, dexmedetomidine, and propofol, describing their mechanisms of action, dosing, onset/duration, elimination, and positive and negative considerations. For analgesics, it discusses fentanyl, hydromorphone, and morphine, providing similar details. The document aims to guide clinicians on appropriate medication selection and dosing for sedation and analgesia in intubated ICU patients.

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mathurarun2000
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555 views2 pages

ICU Sedative and Analgesic Guide

This document provides information on common sedative and analgesic medications used in the ICU. For sedatives, it lists lorazepam, midazolam, dexmedetomidine, and propofol, describing their mechanisms of action, dosing, onset/duration, elimination, and positive and negative considerations. For analgesics, it discusses fentanyl, hydromorphone, and morphine, providing similar details. The document aims to guide clinicians on appropriate medication selection and dosing for sedation and analgesia in intubated ICU patients.

Uploaded by

mathurarun2000
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ICU Sedative Medications

GABAergic

Lorazepam
(Ativan)

GABAergic

Midazolam
(Versed)

MOA

Drug

Dose

1-15
mg/hr

1-15
mg/hr

15-50

(Precidex)

-2 agonist (presynaptic)

Dexmedetomidine

GABAergic (?)

Propofol
(Diprivan)

mcg/kg/min
(Avoid doses
greater than 67
mcg/kg/min for
more than 8
hours)

0.4-1.5
mcg/kg/min
(Bolus dosing
not used in
ICU)

Onset

2-5
min
(After Bolus)

5-20
min
(After Bolus)

Duration

2-4
hrs

4-6
hrs

Liver

(Active
metabolite)

Liver

(No active
metabolite)

30-90
sec
(Bolus or
Infusion)

Liver
3-10
min

Hypotension
common with
bolus dosing!

15-30
min
(Infusion)

Positive Considerations

Elimination

(No active
metabolite)

Cardio-vascular stability
-No bradycardia
-Little hypotension
Low Cost ($)

Cardio-vascular stability
-No bradycardia
-Little hypotension
Low Cost ($)

Negative Considerations

Risk if ICU Delirium (all Benzodiazepines)


Accumulation (Lipophilic compound)
Active Metabolite
Daily Awakenings and Scheduled Dose-Taper
can minimize accumulation

Accumulation (long T )
Consider bolus dosing only
Propylene glycol toxicity
-(High doses, >16 mg/hr X 24 hr)

Hypotension (especial in hypovolemia)


Hypertryglyeridemia (10% lipid emulsion)
-Check serum triglycerides with 48 hrs of
Effective sedative
use
No risk of accumulation
Propofol related infusion syndrome (PRIS)
Easily titratable with no need
-(60-70 case reports)
-ST elevation in leads V1V3
to bolus
-Acidosis
-Electrolyte imbalance (K, Mg, Phos)
-Rhabdomyolysis
-CV collapse, High Mortality (>90%)

Liver
20-30
min

(No active
metabolite)

Unique sedative profile


(Arousability maintained)
ICU Delirium
Opioid sparing
No respiratory suppression
(Patient may remain on
after extubation)

Follow U of I MICU dosing guideline


Most common adverse events:
Bradycardia (10% HR)
Hypotension (10% SBP)
Avoid if patient on paralytic/NMBA!!!
Avoid in hemodynamic shock
Duration of use? Safe in large studies
MENDS (7 days) / SEDCOM (14 days)
High Cost ($$$) may decrease total costs
with shorter LOS in ICU and time on vent.

ICU Analgesic Medications


MOA

Drug

Dose

Equianalgesic
Dose

Onset

Duration

Elimination

Positive Considerations

Fentanyl

Date: Feb 2012

Opioid

Hydromorphone
(Dilaudid)

Opioid

Morphine

Opioid

(Drug of choice
for intubated
patients receive
continuous
analgesia)

Liver
25-300
mcg/hr

100 mcg

1-2 min

1-2 hr

(No active
metabolite)

Liver
2-30* mg/hr

10 mg

0.5-10*
mg/hr

1.5 mg

(Not commonly
used as
infusion)

2-8 min

2-6 hr

(Active
metabolite)

Liver
(7-8 fold more
potent than
morphine)

2-8 min

2-4 hr

(No active
metabolite)

Short duration of action


 Eliminated 1-2 hr after
infusion D/C.ed
Low risk of accumulation

Negative Considerations

Very potent
 Dosing error risk
Respiratory suppression
 Airway stability?
Constipation/Ileus
Fentanyl Induced Rigidity
 Very rare!
 Associated with large
bolus doses

Most clinicians are familiar


Histamine release
with dosing
 Flushing
Longer duration action allows
 Hypotension
bolus dosing without
Constipation/Ileus
continuous infusion
Longer duration action
allows bolus dosing without
continuous infusion
Can be used in renal
dysfunction
No/Less histamine release

Less histamine release


Constipation/Ileus

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