Table 1 Key characteristics of agents commonly used for sedation in intensive care unit (ICU) patients
From: 'Cooperative sedation': optimizing comfort while maximizing systemic and neurological function
Drug | Type of medication | Sedation | Analgesia | Mechanism of action | Advantages | Adverse effects |
|---|---|---|---|---|---|---|
Fentanyl | Opioid | + | +++ | Mu receptor agonist | Reversible, rapid onset, short duration | Respiratory depression, chest wall rigidity, gastric dysmotility, hypotension |
Remifentanil | Opioid | + | +++ | Mu receptor agonist | Reversible, rapid onset, short duration | Respiratory depression, chest wall rigidity, gastric dysmotility, hypotension |
Morphine sulfate | Opioid | + | +++ | Mu receptor agonist | Reversible | Respiratory depression, gastric dysmotility, hypotension, hallucinations |
Diazepam | Benzodiazepine | +++ | + | GABAa receptor agonist | Reversible | Respiratory depression, hypotension, confusion |
Lorazepam | Benzodiazepine | +++ | - | GABAa receptor agonist | Reversible | Respiratory depression, hypotension, confusion |
Midazolam | Benzodiazepine | +++ | - | GABAa receptor agonist | Reversible, shorter duration, and titratable | Respiratory depression, hypotension, confusion |
Dexmedetomidine | Alpha-2 agonist | ++ | ++ | Alpha-2 receptor agonist (pre- and post-synaptic | Maintains cognitive function | Dry mouth, bradycardia, hypotension, adrenal suppression, atrial fibrillation |
Propofol | Â | +++ | - | Unclear | Very short duration, easy to titrate | Hypotension, respiratory depression, metabolic acidosis, rhabdomyolysis, anaphylaxis, sepsis, pain at injection site |