Rapid Sedation in Intubated Patients

Rapid Sedation Options in the ICU

This reference guide outlines commonly used medications for rapid sedation in intubated ICU patients. All styles are inline to ensure your blog formatting is preserved.

Drug	Typical Dose	Onset	Advantages	Cautions
Fentanyl	25–100 mcg IV bolus; may repeat q30–60 min PRN	1–2 min	Rapid analgesia, minimal hemodynamic impact at lower doses	Respiratory depression, chest wall rigidity with rapid/high doses
Propofol (IV Push)	10–30 mg IV bolus, repeat 10–20 mg q1–2 min PRN	Seconds	Rapid onset, short duration, easy titration	Hypotension, bradycardia, apnea if overdosed
Midazolam (Versed)	1–2 mg IV q2–3 min, titrate slowly	2–3 min	Synergistic with opioids, useful for anxiety/withdrawal	Respiratory depression, especially with opioids
Ketamine	0.5–1 mg/kg IV push	1–2 min	Preserves airway reflexes, bronchodilation	Emergence reaction, ↑HR/BP, caution in CAD
Dexmedetomidine	0.5 mcg/kg over 10 min (optional), then 0.2–0.7 mcg/kg/hr	5–10 min	Minimal respiratory depression, cooperative sedation	Bradycardia, hypotension, avoid rapid bolus
Haloperidol	2.5–5 mg IV/IM q15–30 min (max ~20 mg)	10–20 min	No respiratory depression, familiar agent	QTc prolongation, EPS, dystonia
Droperidol	2.5–5 mg IV/IM, repeat q15 min (max 10 mg)	5–10 min	Short half-life, rapid control of delirium	QTc ↑, baseline ECG needed
Olanzapine	10 mg IM (not IV)	15–30 min	Less EPS than haloperidol	Somnolence, avoid with IM benzos

Note: Always titrate to desired effect, monitor hemodynamics and respiratory function, and reassess sedation goals frequently.