Results (Midazolam):

In an intensive care situation, a tranquil patient who is readily awakened but whose normal sleep-wake cycle is preserved is a common target degree of sedation. Mechanical ventilation might be difficult for certain individuals and they may require more sedation to have it done. The risk of overstimulation persists regardless of the sedative agent used. When sedative medicines are used in continuous infusions, there is a larger risk of adverse effects, such as prolonged mechanical breathing and ICU and hospital admissions, and an increased risk of nosocomial infection. Sedation can also cause cardiac or respiratory depression, which must be quickly diagnosed and dealt with to avoid hypoxic brain injury, cardiac arrest, or death. Many sedative drugs, including as benzodiazepines and opioids, may have a prolonged and unpredictable duration of effect in critically sick patients because of the redistribution and accumulation of active metabolites. The accumulation of the parent substance or its active metabolites might lead to undue sedation; hence care should be taken while delivering continuous infusions.
Conversely, a lack of sedation and analgesia can lead to undesirable consequences, such as a patient’s discomfort or harm due to a lack of compliance or unpleasant physiological or psychological responses to stress. To avoid the persistent effects of sedation, the appropriate level of sedation should be determined at the start of treatment and re-evaluated on a frequent basis with active tapering of the infusion rate. The American Society of Health-System Pharmacists (ASHP) and the Society of Critical Care Medicine (SCCM) both support using sedation guidelines, algorithms, or protocols..
The scientific community has not yet agreed on the characteristics of an ideal agent for moderate sedation. Patients can generally anticipate a rapid onset of action, predictability of pharmacodynamics/pharmacokinetics, and a swift restoration of mental and physical faculties with such a drug.
These benzodiazepines, which include diazepam and clonazepam, have long been the most frequently used sedatives in intensive care units and were included in the 2002 SCCM/ASHP clinical practice guidelines for sedation. Apart from its potency and the presence or absence of active metabolites, benzodiazepines have distinct characteristics. It is critical to take caution when delivering benzodiazepines via continuous infusion due to the accumulation of the parent agent or active metabolites, which can result in hours to days of over sedation and tolerance. According to the SCCM/ASHP guidelines, acutely agitated patients should be administered diazepam and midazolam, with midazolam being preferred for short-term usage due to the unexpected awakening and time to extubation associated with infusions lasting more than 48–72 hours. Clonazepam’s gradual onset of effect makes it more suitable for long-term sedation than for acute agitation. It can be given as a continuous infusion or as an intermittent infusion. Flumazenil, a benzodiazepine antagonist, should not be used frequently in patients who have been on benzodiazepines for an extended period of time due to the risk of withdrawal symptoms and increased myocardial oxygen demand.
SCCM/ASHP recommends propofol as the preferred sedative for patients who require rapid awakening (for example, during extubation or neurological testing). Triglyceride monitoring is recommended after two days of propofol infusion, as long-term or high-dose propofol therapy may result in hypertriglyceridemia.
Due to their ease of administration, favorable tolerability profiles, and predictable actions, commonly used sedatives such as intimidate, ketamine, and midazolam (in combination with midazolam), as well as the opioids fentanyl (in combination with midazolam), and remifentanil, have become the agents of choice for procedural sedation from pain that does not respond well to opioid analgesics, such as sympathetically prolonged neuropathic pain, may benefit from the use of 2-adrenergic agonists. The SCCM/ASHP guidelines were issued before it was known whether or not to employ 2-adrenergic receptor agonists to sedate patients in an intensive care unit, despite the fact that current clinical evidence supports their use as sedatives.