Sedatives are the pharmacological agents those have wide uses in recent days practices, analgesics are being used widely.

1. Sedatives & Analgesics
in Intensive Care Unit
Presented to you by
Abiyad Ahmed Classes
Abiyad Ahmed, BS Critical Care (Pursuing), ACLS, FIMHRC

2. Contents
• What is sedatives
• Goals & When to use
• Opioids
• Non-opioids
• Benzodiazepines
• Other intravenous agents

3. Sedative & Analgesics
• Sedation and analgesia are the essential components in the care of a critically ill
patient in Intensive Care Unit settings because agitation is a common issue of
almost all adult critically ill patients.
• Analgesics are the group of drugs that provide pain relief. Broadly these are
classified into two categories i.e. 1) Non narcotic analgesics and 2) Narcotic drugs
• Sedatives are the pharmacological substance that allay irritability or excitement
lowering functional activity. It is also considered as hypnotic drugs.

4. Why these drugs is needed?
• Patient’s comfort
• Anxiolysis & Amnesia
• Reduce O2 consumption
• Pain control
• Ability to tolerate appropriate organ system support
• Avoid accidental incidents by the patient (Example: Extubation)

5. When to use
• Anxious
• Altered mental status
• Facilitate mechanical ventilation
• Complaints of sleeplessness
• As a part of treatment

6. Which agents are being used?
In recent practices, an Intensivist usually
prescribe the following agents:
 Opioids
 Benzodiazepines
 NSAIDs
 Other Intravenous agents (Non Barbiturates)

7. Opioids
Opioids are the primary agents used for analgesia in Intensive Care Unit.
Opioids are lipid soluble, bind to opiate receptors in the central nervous system
and peripheral nervous system as well. At low doses, opioids provide analgesia
but not anxiolysis whereas at high doses, they act as sedatives.

8. Opioids
Characteristics Morphine Fentanyl Remifentanyl Tramadol
Onset Slow Rapid Rapid Rapid
Duration 4-5 hours 1-1.5 hours 0.05 hours 3-4 hours
Doses 2.5-10 mg i.v. 1-5μg/kg i.v. 0.1 μg/kg/min i.v. 50-100 mg, 4 hourly
Systemic actions ↓HR, ↓BP, ↓CNS
↓Ventilation
↓HR, ↓BP, ↓CNS
↓Ventilation
↓HR, ↓BP, ↓CNS
↓Ventilation
----------------
Adverse effects Respiratory
depression, Nausea,
Vomiting
Respiratory
depression, Nausea,
Vomiting
Muscle rigidity,
hypotension,
Bradycardia
Dizziness,
Convulsion, No
respiratory
depression

9. Benzodiazepines
Benzodiazepines, most widely used drugs, are sedative and hypnotic but not
analgesics. The predominant mechanism of action of benzodiazepines on the
nervous system involve activity at the GABA (Gamma aminobutyric acid)
receptor. Metabolism of benzodiazepines occurs in the liver. Effects of the
drugs may be prolonged because of decreased metabolism. The following
agents are being used now-a-days.

10. Benzodiazepines
Characteristics Midazolam Diazepam Lorazepam
Onset < 3 min 3-5min 10-20 min
Dose
Induction 0.05-15 mg/kg i.v. 0.3-0.5 mg/kg i.v. 0.1 mg/kg i.v.
Maintenance 1 μg/kg/min i.v. 0.1 mg/kg i.v. 0.02 mg/kg i.v.
Seduction 0.07 mg/kg 2 mg repeatedly 0.25 mg repeatedly
Systemic effects ↓ Cerebral oxygen
requirement,
↓Ventilation,
Hypotension,
Tachycardia
↓ Cerebral oxygen
requirement,
↓Ventilation,
Hypotension,
Tachycardia
↓ Cerebral oxygen
requirement,
↓Ventilation,
Hypotension,
Tachycardia

11. Non Barbiturates: Propofol
• Propofol is used for continuous infusion for sedation. This drug alters the
sensorium in an extremely rapid dose dependent manner from light
sedation to good analgesia.
• Mechanism of action of propofol is still incompletely understood. The drug
appears to active the GABA receptor within the central nervous system.
Characteristics Propofol
Onset 30 sec
Duration 15-20 min
Dose 1mg/kg i.v.
Half life (t½ ) 0.5-1.5 hours

12. Non Steroidal Anti Inflammatory Drug
(NSAIDs)
Characteristics Ibuprofen Paracetamol
Mechanism of action Block prostaglandin synthesis by
inhibiting cyclooxygenase
enzyme
Inhibits COX in brain
Dose 600mg, 4 times 0.5-1g, 3 times
Medical uses Analgesics, Antipyretics, Anti
inflammatory
Analgesics, Antipyretics
Half life (t½) 2 hours 2-3 hours

13. RAMSAY Sedation Score
Level Response
1 Patient awake and anxious, agitated and/or restless
2 Patient awake, cooperative, accepting ventilation, oriented and tranquil
3 Patient awake, responds to commands only
4 Patient asleep, brisk, response to light glabellar tap or loud auditory stimulus
5 Patient asleep, sluggish, responds to light glabellar tap or loud auditory stimulus but responds to
painful stimulus
6 Patient asleep, no response to light glabellar tap or loud auditory stimulus

14. Adverse effects
• Respiratory depression
• Altered mental status
• Over-sedation
• Gastrointestinal problems
• Drug dependence

15. Thank You!

16. Also read. . .
• Sedatives - an overview | ScienceDirect Topics
• Sedatives, also known as depressants | Student Health and Counseling Services (ucdavis.edu)
• Sedation: Overview, Sedatives and Analgesics, Approach to Sedation (medscape.com)
• Definition of Sedative (medicinenet.com)
• [Table], Prescription Sedatives (Tranquilizers, Depressants) - Facing Addiction in America -
NCBI Bookshelf (nih.gov)
• Focus: Addiction: Prescription Sedative Misuse and Abuse (nih.gov)
• List of 23 Sedation Medications Compared - Drugs.com
• Sedatives | Psychology Today