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Under-sedation can cause hyper-catabolism, immunosupression, hypercoagulability, and increased sympathetic activity.Haemodynamic responses as a measure of sedation are unreliable in the critically ill patient, hence the need for formal sedation scoring.Basic needs such as feeding and hydration require addressing regularly to prevent the symptoms of hunger and thirst.Drugs commonly used for sedation in ICU are listed in Table 2.This includes frequent communication and explanation to the patient by all staff directly involved in their care, both nursing and medical, and relatives.Physiotherapy plays an important role as prolonged immobility may be painful and this can be reduced by daily assessment and treatment.There are many clinical scoring systems in use within the UK; examples include the Ramsay, Addenbrookes, and the Bloomsbury scales (Table 1).

It produces a state of dissociative anaesthesia, profound analgesia, and amnesia. Ketamine is not commonly used as a sedative infusion due to sympathetic nervous system stimulation resulting in increased cardiac work and a rise in cerebral metabolic oxygen consumption. Concerns include extrapyrimidal effects and hypotension from peripheral α It is metabolized in the liver to products with minimal activity; only 1% is excreted unchanged in the urine.Thiopental is now only administered by continuous infusion in the management of refractory status epilepticus.It has a low clearance and, when given as an infusion, its metabolism may become linear (zero order) due to saturation of hepatic enzymes; thus accumulation is a serious concern, and may lead to myocardial depression and immunosupression.Pain is a common problem and may be worsened by invasive and unpleasant procedures.Agitation is thought to occur at least once in 71% of patients in a medical-surgical ICU.

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