Podcast 793: Postintubation Sedation and Analgesia

<p><strong>Contributor: Peter Bakes, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for patients with intracranial bleeds</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Precedex is a milder sedative used in the ICU because it decreases time to extubation and reduces the risk of complications associated with long term intubation</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;"> </span><span style= "font-weight: 400;">Ketamine should be used in hypotensive patients because it does not lower blood pressure, and its bronchodilatory effect is beneficial for asthmatic patients</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;"> </span><span style= "font-weight: 400;">Versed and ativan are the most commonly encountered benzodiazepine sedatives, but they are infrequently used because they increase the risk of delirium and delay extubation</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Benzodiazepines are useful for sedation in patients with delirium tremens</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">For post intubation analgesia, fentanyl is the drug of choice since it has a lower risk of hypotension than is seen in other narcotics</span></li> <li style="font-weight: 400;" aria-level="1"><span