Sedation in neurointensive care: Advances in understanding and practice

Purpose of review: To evaluate the rationale and the pharmacologic options for sedating neurointensive care patients. Recent findings: Sedation is a fundamental element in the neurointensive care unit. Even if the sedative strategy in the neurointensive care unit shares the same general aims with intensive care, the characteristics of the patients in the neurointensive care unit pose other unique challenges and some specific indications. The primary aim of neurointensive care is to maintain adequate cerebral perfusion pressure, to control intracranial pressure, and to maintain an adequate mean arterial pressure. Reducing the brain's metabolic demand is an important treatment strategy, and analgesic and sedative agents are used to prevent undesirable increases in intracranial pressure. There are many different pharmacologic agents available, each with distinct advantages and disadvantages. Summary: The pharmacokinetic and pharmacologic effects of the available sedatives used in neurointensive care patients are reviewed.