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Sedation of the critically ill patient without an artificial airway is a difficult and challenging clinical problem. Careful attention to preparations, selection of appropriate techniques, and monitoring of patient responses during sedation will reduce problems in this patient population. Preparation to provide airway support is essential in the sedation of these patients, and the appropriate training of the clinician is important.

This article discusses the therapeutic and toxic effects of sedative drugs and neuromuscular blocking agents in the critically ill patient. Common misconceptions of drug properties are highlighted and dispelled. A rational plan for the use of each type of drag is described. The appropriate use of sedative drugs may cause withdrawal syndromes; treatment options are outlined.