6. Sedation, Paralysis, and Pain Management of the Critically Ill Obese Patient

  1. Ali A. El Solh MD, MPH3,4,5
  1. Christopher G. Hughes MD1,
  2. Lisa Weavind MD1 and
  3. Pratik P. Pandharipande MD, MSCI2

Published Online: 19 APR 2012

DOI: 10.1002/9781119962083.ch6

Critical Care Management of the Obese Patient

Critical Care Management of the Obese Patient

How to Cite

Hughes, C. G., Weavind, L. and Pandharipande, P. P. (2012) Sedation, Paralysis, and Pain Management of the Critically Ill Obese Patient, in Critical Care Management of the Obese Patient (ed A. A. El Solh), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119962083.ch6

Editor Information

  1. 3

    Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, USA

  2. 4

    Critical Care Western New York Healthcare System, USA

  3. 5

    Western New York Respiratory Research Center Buffalo, NY, USA

Author Information

  1. 1

    Vanderbilt University School of Medicine, Nashville, TN, USA

  2. 2

    Vanderbilt Medical Center and VA TVHCS, Nashville, TN, USA

Publication History

  1. Published Online: 19 APR 2012
  2. Published Print: 16 APR 2012

ISBN Information

Print ISBN: 9780470655900

Online ISBN: 9781119962083



  • Propofol;
  • Dexmedetomidine;
  • Fentanyl;
  • Remifentanil;
  • Cisatracurium;
  • Sedation protocol;
  • Richmond agitation-sedation scale;
  • Spontaneous breathing trial;
  • Spontaneous awakening trial;
  • Delirium


Sedation and analgesia are routinely administered to critically ill patients to prevent pain, anxiety, and patient–ventilator dyssynchrony, to permit invasive procedures, and to reduce stress and oxygen consumption. Oversedation, however, occurs commonly and is associated with longer time on mechanical ventilation and in the ICU; benzodiazepines in particular are associated with increased risk of oversedation and the development of delirium, itself an independent predictor of mortality and worse neuropsychological outcomes. Obesity can have considerable effects on the pharmacokinetics and pharmacodynamics of sedative regimens and, consequently, predisposes patients to additional risk of untoward outcomes. This state-of-the-art review will discuss the effects of obesity on sedative and analgesic pharmacology and provide an evidence-based approach to improving analgesia and sedation paradigms, while aiming to reduce drug accumulation in critically ill obese patients, through goal-directed sedation, spontaneous awakening and breathing trials, avoidance of benzodiazepines, delirium monitoring, and early mobilization.