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New agents for sedation in the intensive care unit
M Maze1, C Scarfini, F Cavaliere
1Sir Ivan Magill Department of Anaesthetics and Intensive Care, Division of Surgery, Anaesthetics, and Intensive Care, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, United Kingdom. m.maze@ic.ac.uk
Critical Care Clinics
|January 5, 2002
Summary
Newer agents like dexmedetomidine and remifentanil offer unique benefits for ICU sedation, analgesia, and anxiolysis. Lorazepam remains a cost-effective option for long-term intensive care unit sedation.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Anesthesiology
Background:
- Intensive care unit (ICU) patients often require sedation, analgesia, and anxiolysis.
- Advances in pharmacotherapy offer improved options for managing these needs.
Purpose of the Study:
- To review recent advances in pharmacologic agents for sedation, analgesia, and anxiolysis in the ICU.
- To highlight the unique properties and potential benefits of dexmedetomidine, remifentanil, and lorazepam.
Main Methods:
- Literature review of recent pharmacologic advances.
- Discussion of drug properties including onset, offset, and side effect profiles.
- Comparative analysis of agent utility in different ICU scenarios.
Main Results:
- Dexmedetomidine provides cooperative sedation, facilitating patient arousal and minimal ventilation interference.
- Remifentanil offers rapid onset and offset, potentially reducing risks of prolonged respiratory depression.
- Lorazepam is a viable, cost-effective option for long-term ICU sedation.
Conclusions:
- Dexmedetomidine and remifentanil represent significant advances in ICU sedation pharmacotherapy.
- The choice of agent depends on patient-specific factors, duration of therapy, and cost considerations.
- Lorazepam continues to be a relevant option, particularly for long-term sedation where cost is a major factor.