Conscious Sedation and Deep Sedation, Including Neuromuscular Blockade



Conscious sedation and deep sedation of intensive care unit (ICU) patients requiring procedures is both common and necessary. Guidelines exist for the sustained use of sedatives, analgesics, and paralytics 1,2 but not for their procedural use. Anecdotal experience serves as the basis for using analgesia when a critically ill patient undergoes bronchoscopy and to not do so when that same patient gets endotracheally suctioned. Few investigations have questioned the historically firm notion that some procedures require sedation and others do not.


Intensive Care Unit Intensive Care Unit Patient Histamine Release Malignant Hyperthermia Deep Sedation 


  1. 1.
    Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically Ill adult. Crit Care Med. 2002;30:119–141.PubMedCrossRefGoogle Scholar
  2. 2.
    Nasraway SA Jr, Jacobi J, Murray MJ, et al. Sedation, analgesia, and neuromuscular blockade of the critically ill adult: revised clinical practice guidelines for 2002. Crit Care Med. 2002;30:117–118.PubMedCrossRefGoogle Scholar
  3. 3.
    Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–1017Google Scholar
  4. 4.
    Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond agitation-­sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338–1344.PubMedCrossRefGoogle Scholar
  5. 5.
    Riker RR, Picard JT, Fraser GL. Prospective evaluation of the sedation-agitation scale for adult critically ill patients. Crit Care Med. 1999;27:1325–1329.PubMedCrossRefGoogle Scholar
  6. 6.
    Myles PS, Leslie K, Mcneil J, et al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-aware randomised controlled trial. Lancet. 2004;363:1757–1763.PubMedCrossRefGoogle Scholar
  7. 7.
    Desbiens NA, Wu AW, Broste SK, et al. Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the support research investigations. For the support investigators. Study to understand prognoses and preferences for outcomes and risks of treatment. Crit Care Med. 1996;24:1953–1961.PubMedCrossRefGoogle Scholar
  8. 8.
    Puntillo KA, Wild LR, Morris AB, et al. Practices and predictors of analgesic interventions for adults undergoing painful procedures. Am J Crit Care. 2002;11:415-429. Quiz 430–411.PubMedGoogle Scholar
  9. 9.
    Sessler Cn, Jo Grap M, Ramsay Ma. Evaluating and monitoring ­analgesia and sedation in the intensive care unit. Crit Care. 2008;12(Suppl 3):S2.PubMedCrossRefGoogle Scholar
  10. 10.
    Reading AE. A comparison of pain rating scales. J Psychosom Res. 1980;24:119–124.PubMedCrossRefGoogle Scholar
  11. 11.
    Gelinas C, Johnston C. Pain assessment in the critically Ill ventilated adult: validation of the critical-care pain observation tool and physiologic indicators. Clin J Pain. 2007;23:497–505.PubMedCrossRefGoogle Scholar
  12. 12.
    Puntillo KA, Morris AB, Thompson CL, et al. Pain behaviors observed during six common procedures: results from thunder project II. Crit Care Med. 2004;32:421–427.PubMedCrossRefGoogle Scholar
  13. 13.
    Kamijo Y, Masuda T, Nishikawa T, et al. Cardiovascular response and stress reaction to flumazenil injection in patients under infusion with midazolam. Crit Care Med. 2000;28:318–323.PubMedCrossRefGoogle Scholar
  14. 14.
    Dhonneur G, Kirov K, Slavov V, et al. Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm: an electromyographic study in humans. Anesthesiology. 1999;90:951–955.PubMedCrossRefGoogle Scholar
  15. 15.
    Gronert GA, Theye RA. Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology. 1975;43:89–99.PubMedCrossRefGoogle Scholar
  16. 16.
    Larach Mg, Rosenberg H, Larach Dr, et al. Prediction of malignant hyperthermia susceptibility by clinical signs. Anesthesiology. 1987;66:547–550.PubMedCrossRefGoogle Scholar
  17. 17.
    Murray MJ, Coursin DB, Scuderi PE, et al. Double-blind, randomized, multicenter study of doxacurium vs. pancuronium in intensive care unit patients who require neuromuscular-blocking agents. Crit Care Med. 1995;23:450–458.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Respiratory ICU, Department of Medicine Pulmonary and Critical Care DivisionIntermountain Medical CenterMurrayUSA

Personalised recommendations