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Troubleshooting review

Sedation and analgesia medications

Prevent awake paralysis and treat dyssynchrony while protecting hemodynamics.

Analgesia and sedation medication monographStatic published ranges and physiologic cautions without patient-specific output.If BP is fallingMedication/hypotension branch.If dyssynchronousWaveform/ventilator mismatch branch.

Review the adult medication monograph

Static fentanyl, propofol, ketamine, midazolam, and dexmedetomidine ranges are presented with physiologic cautions and source links. No patient-specific total dose, concentration-to-volume conversion, or pump rate is produced.

Open medication monograph

Principles

  • Analgesia and sedation should be ready before paralysis when feasible.
  • Choose drug by physiology: shock, bronchospasm, neuro, agitation, hemodynamics.
  • Verify local dosing, pump concentration, and contraindications.

Common buckets

  • Fentanyl: analgesia; watch hypotension/chest wall rigidity at high rapid doses.
  • Propofol: titratable hypnosis; hypotension caution.
  • Ketamine: analgesia/dissociation; useful in bronchospasm/shock contexts but still requires judgment.
  • Midazolam: anxiolysis/amnesia; prolonged sedation/hypotension/delirium concerns.
  • Dexmedetomidine: cooperative sedation/adjunct; bradycardia/hypotension and slower onset considerations.

Evidence and use limits

Last reviewed: 2026-07-23. Designed for: emergency medicine learners, clinicians, EMS, RT, and airway educators.

This is an educational clinical reference, not a bedside order set. Confirm medications, ventilator changes, pediatric dosing, procedures, and escalation decisions against the patient’s physiology, the ventilator in use, and local ED/ICU/anesthesia/pharmacy/RT/EMS/pediatric policy.

Full references · Editorial policy · AARC 2024 ventilator assessment · ATS/ESICM/SCCM lung-protective ventilation · ATS 2024 ARDS update

About this resource
Created by: Kyle Brown MD; Andrew Pirotte, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: EM faculty Reviewed: local ED, ICU, EMS, anesthesia, pharmacy, and pediatric protocol review recommended before bedside teaching rollout. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and clinical-reference guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: kybrown@kumc.edu