Issues in Sedation, Paralytic Agents, and Airway Management

P from the late 1980s suggested that approximately half of the patients in the ICU described their period of mechanical ventilation as unpleasant and stressful, and that their time requiring mechanical ventilation was associated with fear, agony, and panic. In the late 1990s and more recently, publications have suggested that the administration of large quantities of sedation in the ICU leads to prolonged intervals of mechanical ventilation, longer ICU stays, and increased evaluations of patient’s mental status with CT scans.1,2 The administration of sedation has also been associated with the development of posttraumatic stress disorders and memory problems in the recipients.3,4 Finally, the administration of sedation has been associated with the development of nosocomial pneumonia.5 Also, delirium occurs in more than 80% of the patients in the intensive care unit and the administration of sedatives is likely an important contributor.6 Therefore, it is clear the administration of sedation causes many problems for critically ill patients. The benefits of administering sedation are less clear.