The need for appropriate sedation in the intensive care unit is paramount. Critically ill patients are exposed to multiple adverse stimuli stemming from both their illness and their environment. If left unchecked, these stimuli may often produce potentially harmful physiologic sequelae in patients who already have compromised physiologic reserve. The most useful sedative agents in such circumstances are those which are readily titratable and have manageable side effects. This typically focuses discussion on the intravenous administration of analgesic sedatives (opioids), anxiolytic and amnestic sedatives (benzodiazepines, barbiturates, etomidate, propofol), dissociative sedatives (ketamine), and the antipsychotic sedatives (butyrophenones). With ready titratability, though, comes the need for efficient monitoring and assessment of the degree of sedation. While no measure is without bias, this can effectively be done via the subjective means of a sedation scoring scheme or the more objective means of electrophysiologic measurements. It is the combination of pharmacological tools and consistent assessment which will allow the intensivist to readily achieve the desired sedation goal.
Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management