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.
