Contributor: Peter Bakes, MD

Educational Pearls:

When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia
The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine

Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for patients with intracranial bleeds
Precedex is a milder sedative used in the ICU because it decreases time to extubation and reduces the risk of complications associated with long term intubation
Ketamine should be used in hypotensive patients because it does not lower blood pressure, and its bronchodilatory effect is beneficial for asthmatic patients

Versed and ativan are the most commonly encountered benzodiazepine sedatives, but they are infrequently used because they increase the risk of delirium and delay extubation

Benzodiazepines are useful for sedation in patients with delirium tremens

For post intubation analgesia, fentanyl is the drug of choice since it has a lower risk of hypotension than is seen in other narcotics
In the emergency department, intubated and sedated patients should initially be sedated to a RASS of -2 while obtaining imaging, but aim for a RASS of -1 after to decrease side effects and promote earlier extubation

References

Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983-2991.

Garner O, Ramey JS, Hanania NA. Management of Life-Threatening Asthma: Severe Asthma Series. Chest. 2022.

Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015;75(10):1119-1130.

McKeage K, Perry CM. Propofol: a review of its use in intensive care sedation of adults. CNS Drugs. 2003;17(4):235-272.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

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