DRUGS USED IN SEDATION AND ANALGESIA

Aims of Conscious Sedation

Drugs available

Remember each drug by itself does not provide all the requirements for conscious sedation.  They must used in the right proportions and combinations to achieve the desire effect ('balanced anaesthesia' concept)

DRUG Analgesia Amnesia Sedation
Fentanyl +++ + +
Midazolam - ++ +++
Propofol - +++ +++
Ketamine ++ +++ +++

Drugs should be given according to their effects e.g.

Do NOT use midazolam for ANALGESIA
Use midazolam if only SEDATION is what is required

DRUG ADVANTAGES DISADVANTAGES
Fentanyl Excellent analgesia
Short acting
Respiratory depression
Hypotension
Modest sedative
Midazolam Good amnestic
Excellent sedation
Short acting
Can be given IM, intranasal, oral
Reversible with flumazenil
No analgesia
Respiratory depression
Cardiovascularly stable (if used alone)
Propofol Short acting
Rapidly acting
Excellent sedation/amnesia
Potent depression of airway reflexes (increased risk of aspiration)
Respiratory depression
Profound hypotension
Not reversible
Ketamine Can be given IM
Good for children
Excellent sedation/analgesia
Little cardiorespiratory depression
Emergence phenomena
Nightmares
Not reversible

 

DRUG DOSE
Fentanyl 25-50 mcg every 3min IV
Midazolam 0.5-1mg every 3 min IV
Propofol 20mg every 30 sec IV
Ketamine 1mg-2mg/kg IV slowly
4mg/kg IM

All patients should be appropriately monitored