sedation/Analgesia


-- RASS score 0 chillin -1 drowsy most -1 -2, -4 out
-- RASS -2 -3 -4 Seizure , DT , ARDS
-- interrupted pushes
-- always add analgesia to sedation

  • fentanyl

    • firs line to add on sedation (ALWAYS)

    • lipid soluble, will take while to get off

    • 0.5 mcg/kg/min (titrate0.5) can boluss 25mcg q 5min up to 100 mcg, so 25-100 mcg per hour

    • Note: tachy and HTN are sign of pain, it donts affect BP. reversal is Narcan

  • Ketamine → if hypotensive / pain uncontrolled

  • Dilaudid → if longer analgesia needed

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  • Propofol (1st)

    • GABA agonist

    • Quick ON/OFF onset 1 min , get up in 10 mins

    • 5-50 mcg/kg/min , can titrate by 5

    • AE: Hypotension (add Nepi), bradycardia, inc TRG >1000 pancreatitis (every 3 day), Propofol Infusion Syndrome (metabolic acidosis,lactate,CK,RFP,Tele,Chem,TG,)

    • Note: amnesia property, need pain meds add on,

  • Dexmedetomidine/Precedex/Dex (2)

    • α2-agonist, dont need to be on intubation

    • onset 5–10 min,

    • Bradycardia, hypotension; withdrawal if abrupt stop

    • Bolus 0.1 mcg/kg/10 min → 0.2–1.5 mcg/kg/hr

    • Note: they keep their reparatory drive, it cause mild sedation not deep sedation, it needs pain add on too, can also get hypertension

  • Midazolam/versed

    • GABA agonis

    • onset 2–3 min BUT take >30 min be off

    • Bolus 0.5–2 mg → 0.5–8 mg/hr

    • AE: Delirium, resp depression, accumulation,

    • Note: No effect on BP, need pain meds, has amnesia property like propofol. Flomanxel is reversal agent,

  • (never first line-Inc delerium)(3)

  • ketamine (4)

    • NMDA antagonist

    • onset < 1 min, dur 10–20 min

    • AE: Hypertension, Tachycardia, hallucination, ↑secretions

    • Bolus 1–2 mg/kg → 0.2–0.5 mg/kg/hr,

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