title: Remifentanil, ketamine, and fospropofol: a review of alterative continuous infusion agents for sedation in the critically ill.
abstract: Sedation and analgesia are integral aspects in the care of critically ill patients admitted to the intensive care unit. In recent years, many of the commonly used sedative agents in the United States have experienced manufacturing and sterility issues leading to decreased availability. In addition, current practice has shifted to providing lighter levels of sedation as clinicians have gained a better understanding of the consequences of prolonged deep sedation. Benzodiazepines have fallen out of favor due to findings including increased delirium and duration of mechanical ventilation. Alterations in end-organ function in critically ill patients may also lead to varied responses to commonly used sedatives. With numerous factors impacting choice of sedation in the intensive care unit, fospropofol, ketamine, and remifentanil have been considered potential alternatives to standard therapy. The purpose of this review was to discuss strategies for the safe and effective use of fospropofol, ketamine, and remifentanil for continuous intravenous sedation in critically ill patients.
authors.affiliation: Methodist University Hospital, Methodist Healthcare, Memphis, Tennessee (Drs Mohrien and Jones); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, Memphis (Dr Jones); and The Ohio State University Wexner Medical Center, Columbus (Ms MacDermott and Dr Murphy).
authors.forename: Kerry M
authors.initials: KM
authors.lastname: Mohrien
authors.forename: G Morgan
authors.initials: GM
authors.lastname: Jones
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: MacDermott
authors.forename: Claire V
authors.initials: CV
authors.lastname: Murphy
mesh_terms: D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077208:Remifentanil; D012121:Respiration, Artificial / Q000379:methods; D016896:Treatment Outcome; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D007649:Ketamine; C472965:fospropofol; D000077208:Remifentanil; D015742:Propofol