Approach to Sedation

Patient sedation should be goal-directed, rather than reflexively administered.  Generally sedation should fall into one of the categories listed below:

  • Patient and nursing safety in the event of patient agitation:  to enable effective care to be delivered and prevent occurrence of accidental Extubation or removal of vascular access catheters.
  • Where agitation or restlessness compromises patient haemodynamics
  • To facilitate ventilation or minimise patient-ventilator disharmony.
  • Control intra-cranial pressure.
  • Reduce metabolic rate (oxygen consumption) and sympathetic drive.

 
In mild cases of agitation adequate sedation can be administered by regular and/or "pm" administration of one or more of:

  • Haloperidol 2.5-20 mg 6 hrly (PO / NG / IVI)  2.5-10 mg prn IVI for emergencies
  • Clonidine 50-200 g 6-8 hrly PO  15-30 g prn IV (max 3000 g / day) by infusion, 1 kg/h with boluses up to 1 g.kg/hr.  Use 750 g/50ml D5W via syringe pump.  Start infusion at 4 mls/h with boluses of 2mls x 2/h PRN.  Stop/reduce infusion if hypotension is significant.
  • Diazepam 2.5 – 10mg 8hrly (PO / NG / IVI)  5-10 mg prn IVI.

 
Where an infusion is deemed necessary, this should be goal directed with a sedation end-point specified according to a designated sedation score.

Indications for Propofol sedation:

    • Post cardiac surgery

    • Post cardiac arrest

    • Predicted sedation of <12 hours

    • Coma with normal ICP

When sedation is no longer required, Propofol should be stopped and not weaned, unless discussed with SMO.

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Page last reviewed: 14 May 2014
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