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ICU sedative, analgesics, paralytics table

Drhyo 2025.11.16 20:23 Views : 17

1. Sedatives

Medication Starting Dose Typical Range Pros Cons / Precautions
Propofol 5–10 mcg/kg/min 5–50 mcg/kg/min Fast on/off, good for neuro exams, decreases ICP Hypotension, hypertriglyceridemia, PRIS (rare)
Dexmedetomidine (Precedex) 0.2 mcg/kg/hr 0.2–1.5 mcg/kg/hr Minimal respiratory depression, less delirium, good for weaning Bradycardia, hypotension, cannot achieve deep sedation
Midazolam (Versed) 1–2 mg/hr 2–7 mg/hr Good for deep sedation, seizures Delirium, accumulation, prolonged awakening
Lorazepam (Ativan) 1–4 mg IV q2–6h Avoid continuous infusion Long-acting, good for seizures Propylene glycol toxicity, heavy delirium risk
Ketamine (ICU analgesia/sedation adjunct) 0.1–0.3 mg/kg/hr 0.1–1 mg/kg/hr Maintains BP, bronchodilator, less delirium Hallucinations, tachycardia, hypersalivation

2. Analgesics (Always treat pain first)

Medication Starting Dose Typical Range Pros Cons / Precautions
Fentanyl infusion 25–50 mcg/hr 25–200+ mcg/hr Hemodynamically stable, rapid onset Chest wall rigidity (rare), accumulation
Hydromorphone infusion (Dilaudid) 0.2 mg/hr 0.2–0.6 mg/hr Good for opioid tolerance Long half-life, accumulates in renal failure
Morphine 2–4 mg IV q2–4h — Good analgesia Histamine release → hypotension; renal accumulation

3. Paralytics (Only with deep sedation)

Medication Bolus Dose Infusion Dose Notes
Cisatracurium 0.1–0.2 mg/kg 1–3 mcg/kg/min Best in renal/hepatic failure (Hoffman elimination)
Rocuronium 0.6–1.2 mg/kg 5–12 mcg/kg/min Prolonged action in renal/hepatic disease
Vecuronium 0.1 mg/kg 1–2 mcg/kg/min Avoid in renal/hepatic impairment

4. Quick Reference Targets

Parameter Goal
RASS –1 to 0 (light sedation)
Pain Control CPOT < 3
Propofol Triglycerides Check every 72 hours
Neuromuscular Blockade (NMB) Train-of-four 1–2 twitches
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