In intensive care units sedation is an integral part of management. It reduces stress and anxiety, improves toleration of ventilation techniques, and eases nursing care.
A review by some Canadian doctors of sedation methods in North American and European practice, published in the Journal of the American Medical Association for March 15, suggests that evaluation of the various agents available through randomised controlled trials has been inadequate.
A survey of trials so far published indicates that propofol is at least as effective as midazolam in inducing desirable levels of sedation in intensive care. Propofol permits earlier extubation but more often leads to problems of hypotension. There seems little difference in effectiveness between midazolam and lorazepam. Isoflurane requires a briefer period of intubation than does midazolam, and it produces better sedation in those patients requiring it for less than 24 hours. Ketamine is as effective a sedative as fentanyl in patients with head injuries, and it has less adverse effect upon blood pressure.
The overall conclusion of the survey is that more trials of the relative effectiveness of the available sedative agents, and studies of the relative costs they involve, are called for.