Controlling sedation rather than sedation controlling you.

Sedation in the intensive care unit (ICU) aims to improve patient comfort and facilitate treatment procedures. Most units still rely on a combination of opioid and benzodiazepines with the addition of other drugs for specific requirements. However, the effect of sedative agents in critically ill patients is often unpredictable, so frequent assessment of the depth of sedation is essential to match the depth to patient requirements. In the 1990s, heavy sedation and paralysis is not considered appropriate for many ICU patients; a minimum sedation approach limits cardiovascular or respiratory depression and enables earlier weaning and extubation of patients. Administering sedative agents by continuous infusion is convenient but, unless the level of sedation is reassessed regularly, many patients may become over-sedated. The use of propofol for short-term sedation in ICUs has allowed the maintenance of sedation to continue until just a few hours before extubation but the benefits of propofol for longer-term indications are more debatable. Closer titration of dose and desired effects could also be achieved by a patient-controlled system. The technique may not be suitable for a large number of patients, particularly early in their ICU stay but, for long-term sedation and in the weaning phase--of sedation as well as ventilation--the utility of a drug delivery system truly controlled by the patient should be further explored. The ICU has been succinctly described as an environment in which 'anxiety is prevalent, pain frequent, rest difficult and sleep impossible'. Sedation in the ICU has the double objective of relieving patient distress as well as facilitating treatment procedures.(ABSTRACT TRUNCATED AT 250 WORDS)