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Table 2 Suggested options for sedation–analgesia after acute brain injury, according to clinical scenario and organ function

From: Optimizing sedation in patients with acute brain injury

Indication

First-line sedative

First-line analgesic

Alternatives

‘Standard’ sedation, no ICP elevation

Propofol

Fentanyl

Sufentanil

 

Midazolam

Morphine

Remifentanil

Elevated ICP

Propofol

Fentanyl

Sufentanil

 

Midazolam

Morphine

Remifentanil

Targeted temperature management

Propofol

Fentanyl

Sufentanil

 

Midazolam

Morphine

Remifentanil

Status epilepticus

Propofol

Fentanyl

Sufentanil

 

Midazolam

Morphine

Remifentanil

Liver dysfunction

Propofol

Fentanyl

–

  

Sufentanil

 
  

Remifentanil

 

Renal dysfunction

Propofol

Remifentanil

–

Haemodynamic instability

Midazolam

Fentanyl

Ketamine

Agitation, delirium

α2-agonists

Fentanyl

Antipsychotics

  

Morphine

 
  1. ICP intracranial pressure