Critical Care >Analgesia, Sedation, and Neuromuscular Blockade

John M. Oropello, Stephen M. Pastores, Vladimir Kvetan+

Table 16–4Sedating medications.

Drug IV Loading Dose Infusion Rate Time to Onset Elimination Half-Life* Active Metabolites Notes

Active metabolites
Yes (α-hydroxy-
especially important in
midazolam and
Midazolam 0.01-0.05 mg/kg 0.02-0.1 mg/kg/h 2-5 min 1.7-2.6 h renal failure; adverse
conjugated α-hydroxy-
effects—hypotension,
midazolam)
respiratory depression

Propylene glycol (carrier

solution) can cause
Lorazepam 0.02-0.04 mg/kg 0.01-0.1 mg/kg/h 15-20 min 11-22 h No acidosis; adverse
effects—hypotension,
respiratory depression

Soybean oil and lecithin

carrier (avoid with egg
allergy) Adverse effects:
hypotension, respiratory
Propofol 0.1-0.3 mg/kg 5-50 μg/kg/min 1-3 min 4-23 h No depression, propofol-
related infusion syndrome,
pain on injection,
hypertriglyceridemia,
pancreatitis

Adverse
effects—bradycardia and
Dexmedetomidine 1 μg/kg over 10 min 0.2-0.7 μg/kg/h 5-10 min 1.8-3.1 h No hypotension, hypertension
with loading dose; difficult
to achieve deep sedation

*For short-term infusions. Half-lives can be significantly longer after longer infusions given context-sensitive half-time (see text).

Adapted with permission from Barr J, Fraser GL, Puntillo K, et al: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit, Crit Care Med 2013
Jan;41(1):263-306.

Date of download: 01/01/23 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.