Pharmacology, metabolism and nutrition: Edited by Stanley A. NasrawayThe pharmacology of oversedation in mechanically ventilated adultsDevlin, John WAuthor Information Northeastern University School of Pharmacy, Boston, Massachusetts, USA Correspondence to John W. Devlin, PharmD, FCCM, FCCP, Northeastern University School of Pharmacy, 360 Huntington Ave, Mugar Building #206, Boston, MA 02115, USA Tel: +1 617 373 8171; fax: +1 617 373 7655; e-mail: [email protected] Current Opinion in Critical Care: August 2008 - Volume 14 - Issue 4 - p 403-407 doi: 10.1097/MCC.0b013e32830280b3 Buy Metrics Abstract Purpose of review To review pharmacological-related factors that affect the incidence of oversedation in mechanically ventilated adults. Recent findings Recent epidemiologic studies have identified a high frequency of oversedation in the ICU that is attributable, in part, to a number of pharmacokinetic, pharmacogenetic, and pharmacodynamic factors. New evidence suggests that the administration of benzodiazepines, even when dosed intermittently, will lead to more oversedation than either propofol or dexmedetomidine and is associated with greater healthcare costs. Based on this data, clinicians should limit the use of benzodiazepines to those patients with anxiety, seizures, alcohol withdrawal, or in whom a deeper level of sedation or therapeutic paralysis is required. Summary Recognition of these new advances will help liberate patients from mechanical ventilation sooner, without compromising patient comfort. © 2008 Lippincott Williams & Wilkins, Inc.