Sedation in the intensive care unitYoung, Christopher MD; Knudsen, Nancy MD; Hilton, Andrew MD; Reves, J. G. MDCritical Care Medicine: March 2000 - Volume 28 - Issue 3 - pp 854-866 Review Abstract Author Information Abstract Objective: To describe the goals of sedative use in the intensive care unit and review the pharmacology of commonly used sedative drugs as well as to review pertinent publications in the literature concerning the comparative pharmacology of these drugs, with emphasis on outcomes related to sedation and comparative pharmacoeconomics. Data Sources: Publications in the scientific literature. Data Extraction: Computer search of the literature with selection of representative articles. Synthesis: Proper choice and use of sedative drugs is based on knowledge of the pharmacology of commonly used agents and is an essential component of caring for patients in the intensive care unit. The large variability in pharmacokinetics and pharmacodynamics in the critically ill make it difficult to directly compare agents. Midazolam provides rapid and reliable amnesia, even when administered for low levels of sedation. Propofol may be useful when deeper levels of sedation and more rapid awakening are required. Lorazepam can be used for long-term sedation in more stable patients if rapidity of effect is not required. Further investigation in assessment of depth of sedation in the critically ill is needed. Continued study of costs, side effects, and appropriate dosing strategies of all sedative agents is needed to answer questions not sufficiently addressed in the current literature. Conclusion: An individualized approach to sedation based on knowledge of drug pharmacology is needed because of confounding variables including concurrent patient illness, depth of sedation, and concomitant use of analgesic agents. Author Information From the Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC. Supported, in part, by an unrestricted educational grant from Roche Laboratories. Address requests for reprints to: Christopher C. Young, MD, Box 3094 Duke University Medical Center, Durham, NC 27710. © 2000 Lippincott Williams & Wilkins, Inc.