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Sedative-analgesic medications in critically ill adults: Properties, dosage regimens, and adverse effects

Karen J Tietze, PharmD
Barry Fuchs, MD
Section Editors
Polly E Parsons, MD
Michael Avidan, MD
Deputy Editor
Geraldine Finlay, MD


Distress, due to pain, fear/anxiety, dyspnea, or delirium is common among critically ill patients, especially those who are intubated or are having difficulty communicating with their caregivers [1]. Distress may manifest clinically as agitation that is often associated with ventilator asynchrony and vital sign abnormalities. Regardless, distress needs to be treated to comfort the patient, ameliorate agitation that may interfere with supportive care, and attenuate increases in sympathetic tone, which may have untoward physiological effects [2].

Common sedative-analgesic medications used to treat distress in critically ill adults are reviewed here. Identifying the cause of distress and using this information to select the optimal sedative-analgesic agent is discussed separately. (See "Sedative-analgesic medications in critically ill adults: Selection, initiation, maintenance, and withdrawal".)

The management of pain and neuromuscular blockade in critically ill patients is also described separately. (See "Pain control in the critically ill adult patient" and "Clinical use of neuromuscular blocking agents in critically ill patients".)


Pain can be managed in the intensive care unit (ICU) with opioid analgesic and nonopioid analgesic agents. The choice of agent should be directed at the etiology of pain, but opioids are, in general, frequently administered for the management of pain in mechanically ventilated patients.

Opioid analgesics — Morphine sulfate, fentanyl, and hydromorphone are the intravenous opioids that are most commonly used to manage distress due to pain in critically ill patients. Oral opioids such as oxycodone, methadone, and morphine are also given to patients where oral or enteral administration is preferred. Remifentanil is also an option; advantages include its rapid onset of action and prompt clearance that are independent of hepatic and renal function, although there is debate as to whether its use is associated with a higher risk of tolerance [3-5].

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Literature review current through: Nov 2017. | This topic last updated: Jun 15, 2017.
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