Below are some of the important considerations when using sedation.

Sedation breaks (holidays)

• Involve the daily stopping of continuous sedative and analgesic infusions.
• Allow the patient to waken. If he or she requires sedation or analgesia, it is recommenced at a lower rate (e.g., half) with further titration of sedatives or analgesics to a targeted sedation score.
• Are performed safely as long as patients are appropriately monitored by nursing and medical staff for awakening and there is timely resumption of sedation or analgesia where appropriate.
• Are contraindicated in patients under neuromuscular blockade and where fluctuations in blood pressure and oxygen consumption may be detrimental, e.g., neuro-ICU, traumatic brain injuries and heart failure with critical ventricular function.
• Have been found to reduce the duration of mechanical ventilation, ICU stay and the number of investigations performed to explain prolonged coma following withdrawal of sedation.

Withdrawal syndromes

• Withdrawal syndromes can occur with most sedatives and all opioids.
• Patients at risk:
  • Those who have been in ICU for more than 7 days.
  • Those on high sedative and analgesic doses.
• Management includes:
  • The gradual tapering of doses.
  • Consideration of conversion to longer-acting agents.
  • Consideration of the use of clonidine to control symptoms.
  • Multimodal analgesia.

Non-pharmacological methods

• These are important, often very simple ways of reducing patient discomfort.
• They include:
  • The proper positioning of patients, including the stabilization of fractures.
  • Comfortable temperature.
  • Adequate hydration, bowel and bladder care.
  • Physiotherapy, patient activity and regular turning.
  • Removing unpleasant physical stimulation, for example traction on tubes and drains, lying on lines and connectors.
  • TENS (transcutaneous electrical nerve stimulation), heat and cold therapy, massage and music.