Sedation Regimen for Intubated Asthmatic Patients

Medications and Initial Doses

• The American Heart Association recommends propofol infusion at 5-50 mcg/kg/min (0.3-3 mg/kg/h) as the primary agent, with fentanyl as an analgesic and midazolam as a complementary sedative if necessary, for a 59 kg intubated asthmatic patient 1
• Fentanyl dosage is 25-50 mcg IV (0.5-1 mcg/kg) every 1-2 hours as needed, which translates to approximately 30-60 mcg IV for a 59 kg patient 2
• Midazolam dosage is 1-2 mg IV every 2-4 hours as needed 2

Monitoring and Adjustments

• Vital signs should be monitored every 15 minutes for the first hour, then hourly, with a focus on blood pressure, as propofol can cause hypotension 1
• The Richmond Agitation-Sedation Scale (RASS) score should be assessed hourly, with a target score of -2 to 0 1
• Auto-PEEP should be monitored hourly, as it can lead to barotrauma and hemodynamic compromise 1

Special Considerations for Asthmatic Patients

• Sedation should be avoided in non-intubated asthmatic patients, as it can depress the respiratory center 3, 4
• In intubated asthmatic patients, adequate sedation should be maintained to prevent fighting against the ventilator and auto-PEEP 1
• Ventilation with low tidal volumes (6-8 ml/kg) and slower respiratory rates should be used to allow for adequate exhalation 1

Weaning Strategy

• Daily sedation interruption should be performed to assess neurological status and possibility of extubation, with consideration of extubation when the patient is alert, follows commands, and has adequate respiratory function 1