Best sedation med

**NICU Guy, BSN, RN** · Jan 29, 2019

Best sedation medication, for what purpose? Depending on the situation, you may or may not want to use one of your choices.

Wuzzie · Jan 29, 2019

As the previous poster said each of them have pros and cons that vary with each situation and patient. For example Propofol is often used for short procedures and conscious sedation but because of its lipid base is often passed over for something else in long term sedation scenarios. Propofol makes me vomit violently for at least 12 hours post-procedure so if I have to have a procedure I discuss this with the anesthesia team so they can use an alternative if possible. If they can’t then they can be prepared for the onslaught that is sure to come.

subee, MSN, CRNA · Jan 30, 2019

Homework?

AnnieNP, MSN, NP · Jan 30, 2019

? FOR WHAT?

miamiheatrn, BSN · Jan 31, 2019

For example, just basic management of your intubated ICU patient. Particularly, the ones who are hemodynamically unstable with low BP's? In my ER we use Etomidate for pretty much all RSI's. Even sepsis which supposedly is contraindicated because of adrenal insufficiency it may cause. Precedex is good to wean patients off vents I understand because of lack of respiratory depression. Lastly, Versed/fentanyl have less of a potent hypotensive effect than propofol, is this correct?

murseman24, MSN, CRNA · Feb 10, 2019

On 1/30/2019 at 9:54 PM, miamiheatrn said:
For example, just basic management of your intubated ICU patient. Particularly, the ones who are hemodynamically unstable with low BP's? In my ER we use Etomidate for pretty much all RSI's. Even sepsis which supposedly is contraindicated because of adrenal insufficiency it may cause. Precedex is good to wean patients off vents I understand because of lack of respiratory depression. Lastly, Versed/fentanyl have less of a potent hypotensive effect than propofol, is this correct?

Sounds like you have a pretty good working knowledge already. Do you have a specific question regarding these meds? In our ICU we used Prop/Fentanyl as the standard, but if hemodynamically unstable we dropped the propofol for Versed or Ativan.

KeepinitrealCCRN · Feb 10, 2019

I like prop/fent because you can bolus them and titrate them easily. I also love versed but it is not our go-to drug. Personally, I hate precedex because you can't bolus it, it doesn't really work and almost always causes bradycardia. Precedex is good to take the edge off or ETOH withdrawl but not great for intubated pts who need something stronger.

murseman24, MSN, CRNA · Feb 11, 2019

13 hours ago, KeepinitrealCCRN said:
I like prop/fent because you can bolus them and titrate them easily. I also love versed but it is not our go-to drug. Personally, I hate precedex because you can't bolus it, it doesn't really work and almost always causes bradycardia. Precedex is good to take the edge off or ETOH withdrawl but not great for intubated pts who need something stronger.

Precedex was the only thing we were allowed to keep on when we were coming off the vent, so it was used to that end. But yeah, I wouldn't call it a "strong" med for sedation purposes.

EllaBella1, BSN · Feb 26, 2019

Yeah, precedex isn't my favorite. Except for the etoh-ers in DTs who aren't tubed.

Ketamine works pretty well in hypotensive patients but I haven't seen it used that often.

Pheebz777, BSN, RN · Mar 3, 2019

Here is the best write up for sedation agents.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227310/

You would also benefit from watching the numerous YouTube videos on this subject.

adventure_rn, MSN, NP · Mar 11, 2019

This is an interesting thread. It's funny to hear that the adult world isn't a fan of precedex; from a peds perspective, we LOVE precedex in my PICU. We have to run boluses over 5-10 mins to prevent bradycardia, but it mellows the kids right out. Granted, since they're tiny we can literally hold them down for the 5-10 mins it takes to infuse so they don't tear out their ETTs while it takes effect (vs. adult patients). 90% of our kids are on a precedex/fentanyl combo. Usually the fentanyl doesn't touch them, but the dex knocks them out.

We'll give ketamine, ativan and versed for one-time procedural pain (like a-line placement), but rarely as PRNs or drips since it causes crazy delirium and paradoxical reactions in kids. Once in a blue moon we'll use prop if a kid is trying to actively tear out their ECMO cannulas or having pulmonary hypertensive death spells, but we have to shut it off before 12 hours due to the concern for propofol infusion syndrome. However, for those handful of 'sedation nightmare' kids, it feels like a miracle drug; I'm always sad to shut it off at hour 11 because I know I'll be running my tail off for the rest of the shift to keep the kid sedated and settled.