Post-intubation Sedation and Analgesia in the Emergency Department: The Basics and Beyond

Provision of postintubation sedation and analgesia is critical in emergency management of mechanically ventilated patients. Pain and sedation should be monitored using a validated scoring system, and medications titrated to a target sedation level, which should usually be light. Usually, fentanyl is the first-line analgesic and propofol is the first-line sedative. Dexmedetomidine and ketamine may be helpful in select populations, but further research is needed to define their role in the emergency department. Benzodiazepines should generally be avoided. Physicians should plan for postintubation sedation and analgesia in advance and consider using succinylcholine for intubation to avoid awareness with paralysis.