Intensive care: problems of over- and undersedation

The goal of sedation therapy is to make patients rousable, calm, comfortable, co-operative and communicative. A careful control of analgesia, anxiety and hypnosis can achieve this goal. Integral to any sedation protocol is a sedation scoring system so that the infusion is targeted towards a sedation level rather than a set dose. A continual assessment of the patient is essential, together with regular adjustments to the infusion rate. Following these guidelines, the clinician can avoid the hazards of undersedation—patient self-injury, increased catecholamine production with increased oxygen consumption and haemodynamic instability, severe anxiety and the development of post-traumatic stress disorder—and of oversedation—an increased time on mechanical ventilation, a prolonged stay in the intensive care unit and cerebral or cognitive complications. Severe respiratory depression, which may result in hypoxia, hypercarbia and cardiac arrest, can also be avoided. Effective sedation therapy results in enhanced patient safety, a better quality of care and more cost-effective management