Critical Care Medicine-Neurologic Disorders>>>>>Analgesia, Sedation and Neuromuscular Blockade
Question 3#

You have just intubated a patient for respiratory failure and will be initiating a sedation regimen.

Which of the following would be the LEAST preferred choice for sedation?

a. Midazolam
b. Propofol
c. Fentany
d. Dexmedetomidine
e. Hydromorphone

Correct Answer is A

Comment:

Correct Answer: A

The 2018 Society for Critical Care Medicine Clinical Practice Guidelines for management for pain and agitation/sedation recommend propofol or dexmedetomidine over benzodiazepines for sedation for shorter duration of mechanical ventilation. Benzodiazepine-based sedation regimens are strongly associated with ICU delirium and thus are the least preferred choice. The guidelines also recommend a protocol-based pain assessment for treating pain before assessing the need for sedation.

Reference:

  1. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825-e873.