Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development

Table 1 Effects of sedatives pertinent to their use/suitability in the management of morbidly obese patients

Sedative		Pharmacokinetic data or experience available in obese patients?	Non-intubated sedation		Intubated sedation		Short-term sedation	Long-term sedation	Deep sedation
Sedative			Upper airway patency	Respiratory drive	Respiratory rate	Muscle weakness	Short-term sedation	Long-term sedation	Deep sedation
Alpha-2 agonists (primarily dexmedetomidine)		No	+	+	+	+	Yes	Yes	No
Benzodiazepines		No	--	+	-	-	No or maybe	No	Not alone
Propofol		Yes	-	-	-	-	Yes	Yes, but not to exceed 6 days without interruption	Yes
Volatile anaesthetics		Yes	+	+	+	+	Yes	?	Yes
Volatile anaesthetics		Yes	+	At ‘ambient’ (i.e. very low) concentrations	+	+	Yes	?	Yes
S-ketamine		?	+	+	+	+	- or + (Assumes use at low dose, in combinations)	Maybe yes, maybe no	Yes
Opioids			-	--	- or +	+			No
	Remifentanil	Yes					Yes	Yes
	Fentanyl, alfentanil, sufentanil	Yes					Yes	Yes
	Morphine, oxycodone	Yes					Yes	Maybe yes, maybe no
Barbiturates		Not resolved						In special groups	Yes

A plus sign indicates an affirmative effect or no adverse effect; a minus sign indicates at least a potentially adverse effect; two minus signs indicates a greater adverse effect or greater potential for an adverse effect.
Bold type indicates that there is at least some evidence to support this characterization. Assessments otherwise reflect expert opinion based on what the experts themselves regard as inadequate or incomplete objective evidence.

ISSN: 2049-6958