Sedation in the Critical Care Unit

Providers encounter unique challenges in the sedation of neurocritically ill patients. Sedative selection requires thoughtful consideration of the risks and benefits of specific pharmacologic agents. Sedative agents should provide enough sedation to maintain patient comfort while allowing frequent and accurate neurologic examinations during sedation interruption. The ideal sedative agent is patient-specific, taking into account the pharmacokinetic and pharmacodynamic characteristics of the drug and patient, drug interactions, and comorbid conditions. While analgosedation is preferred by critical care guidelines, more traditional sedatives that have been used for the routine sedation of brain-injured patients include propofol, dexmedetomidine, benzodiazepines, and ketamine. Butyrophenones such as haloperidol have a limited place in the management of neurocritical patients. A working knowledge of available sedatives and significant neurocritical care sedative concepts are essential for ensuring safety while optimizing patient outcomes.