Hospitals & Services

Management

​Indications

Primarily sedation is given to reduce agitation, which most frequently results from a patient's response to pain and other discomforts.  However there are many other reasons why a patient may become agitated.


​Pain​Opiods, Regional Analgesia
​Anxiety​Benzo-diazapam's, reassurance
​CVS Dysfunction​a / β blockers ACEI's
​Resp & Ventilator dyssynchrony​Newer modes eg. Bi-Level
​Neurological & CIP control​Osmotherapy CSF drainage
​Physical & Environment​Ear plugs reposition
​Delerium​Haloperidol treat cause, e.g. infection

 


Nurses are an invaluable source of information; ask them, "How's the sedation going?"  You will gain a much better appreciation of the effort required to manage a patient's agitation by asking open-ended questions.  It is important to think about exactly why the patient is receiving sedation, especially if the depth of sedation, e.g. as determined by the Richmond Agitation Scale (RASS), is greater than desired.  If the level of sedation seems deeper than desirable, your next question might be: "Does the patient need to be so sleepy?"  Often sedation is given for reasons not related to agitation, such as hypertension.  If there are better therapeutic options, these must always be considered.  While giving increased sedation may be initially useful to gain control, it is often not helpful in the long term.  Specifically, conditions that cause agitation or some of its manifestations should be identified and managed concurrently.  Figure 1 provides a rational approach to using sedation in critically ill patients.

Page last reviewed: 08 December 2016
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