What are you using for sedation?

[kgriffiRN]

In the ICU that I work in we have general vent sedation orders along with a diprivan protocol for patients that need sedation. Typically we'll start patients on a diprivan drip and we are allowed to either titrate the drip up and/or give additional sedation such as morphine, versed, norcuron for desired effect. Lately I've seen a big push at other facilities to stop using diprivan and start using meds like precedex. So I'm curious, what are you using for sedation in your facility? And how do you feel about the sedation your unit is using?

[sunnycalifRN]

We seldom use diprivan because of the nationwide shortage, and the frequent hypotension. Good old fentanyl and versed is our mainstay for sedation. We use dex with patients that don't wake up nicely. I was kind of surprised to see norcuron on your list of meds. We don't use it as part of our sedation protocol.

[pinkpig]

fentanyl and midazolam are our mainstays. we limit propofol for the hard to sedate. I think we are trying to use precedex more, not sure the rationale but I think it's more expensive.

[sunnycalifRN]

Precedex (dexmedetomidine) is great for the patients that get very agitated when the sedation is off; the nice thing about dex is that it doesn't suppress the respiratory drive and you can extubate with the dex drip running. You are right, it is expensive, but so is a longer stay in the ICU.

[SILRN]

hey everyone, new to the forum. We use diprivan as a mainstay and depending on the difficulty of sedation we will add in fentanyl/versed or something similar. 9/10 pts on sedation are on diprivan and I hate it because it seems to be so much more difficult for weaning trials. Not to mention a majority of our pt's have been CABGs and come back on every presser known to man so you are titrating dobutamine, dopamine, levophed...etc and trying to keep your pressure from going too soft with the diprivan. Most of the hospitals in my area are trying to get away from the diprivan because of the later effects due to it's storage in fat cells.

[meandragonbrett]

propofol, fent, versed, ativan, haldol

[Da_Milk_of_Amnesia, MSN]

Propofol, and ativan versed for our sedation protocols. Morphine and fent. for our pain protocols, usually both are instituted when we snow someone because most of what we deal with is trauma. Then the usual PRNs Haldol, ativan Morphine.

Unfortunately my hospital is too cheap/poor for percedex. Altho with some of the patients we have and the things I've heard about this drug, It sounds like something we could def benefit from.

[Schuur451]

We use mostly propofol, occasionally versed. It's up to our physicians.

In terms of cost, I think there is a study comparing total costs of using midazolam vs dexmedetomidine, that showed dex actually ended up costing less. I heard about it in a Society of Critical Care Medicine (SCCM) podcast. I'll include the link below for anyone interested. It's pretty dry, with lots of statistics vocabulary.

http://www.sccm.org/Publications/iCritical_Care/Pages/Podcast_Archive.aspx

Top of the page, #131

[BacktoBasics]

Fentanyl and versed.

[angle85]

We use mostly Ultiva (remifentanyle) for sedation despite its analgesic, and recently we start using Precedex (dexmedetomidine) with some patients.

In rare cases may need extra morphine or Dormicum (midazolam).

[bellehill, RN]

We use Propofol in our neuro ICU simply because it wears off so quickly for our hourly assessments. Precedex is tried and we have seen that it tends to work better on some than others (not sure if it is a brain thing). We just had the Precedex rep do an inservice and it is recommended to be started at the beginning of agitation or even before which never happens. We also use Fentanyl and Versed for our hard to control patients but we also saw an increase in ileus with the Fentanyl. Personally, I like the Propofol. It is quick and has a short half life for our neuro exams.