Historically patients in intensive care were heavily sedated and often paralysed.  As modes of ventilation have evolved, it has become desirable for patients to be more neurologically accessible.  Anxiolysis and analgesia to treat agitation, not sedation, are the primary goals in the management of the critically ill patient.

Pain and anxiety are associated with significant adverse physiological responses:

  • Sympathetic overdrive

  • Intra-cranial hypertension

  • Gastritis and gastric erosion

  • Excessively catabolic state

This needs to be weighed against the adverse effects associated with over-sedating a patient:

  • Respiratory depression

  • Prolonged ventilation and associated risk of nosocomial infection

  • Eventual emergence phenomena with sympathetic overdrive, delirium and withdrawal

  • Hypotension

  • Gastroparesis

Prolonged stay with unnecessary use of resource, and increased risk of complications


Page last reviewed: 14 May 2014