Sedatives and antagonists in the management of severely head-injured patients.

Continuous intravenous sedation is often prescribed during the intensive treatment of severe head injury. It is known that intravenous hypnotics may prevent or treat the brief intracranial hypertension episodes associated with nociceptive stimuli, like tracheal intubation. However there is yet no clear evidence in the literature showing beneficial effects of sedation in severely head-injured patients on intracranial pressure control or outcome. Sedation should be primarily administered in neurotraumatology to allow good conditions for intensive treatment, while avoiding any depressive cardiovascular action. The abrupt reversal of sedation by means of specific antagonists may induce significant elevation of both cerebral blood flow and intracranial pressure and should be avoided.