Comparative Efficacy and Safety of Sedative Agents in Severe Traumatic Brain Injury

  • D. J. Roberts
  • D. A. Zygun
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)


Sedative agents are commonly used to manage adults in the intensive care unit (ICU) with severe traumatic brain injury (TBI) [1–3]. These drugs prevent or treat agitation, permit manipulation of artificial ventilation, and induce and maintain anxiolysis and amnesia [1–3]. Moreover, sedative agents may diminish cerebral metabolic rate and, through flow-metabolism coupling, reduce brain blood flow, intracranial blood volume, and ultimately intracranial pressure (ICP) [4]. Boluses or infusions of sedatives possibly also reduce the prolonged and marked increases in ICP produced by endotracheal suctioning or bronchoscopy [3, 5]. Unfortunately, however, sedative agents may also lower mean arterial pressure (MAP), hinder the neurological examination, and prolong the length of ventilatory support or ICU stay [3]. This chapter reviews regulation of brain blood flow and metabolic rate in TBI, relevant sedative neuropharmacology, and the comparative efficacy and safety of propofol, ketamine, etomidate, and agents from the opioid, benzodiazepine, α2-agonist (i.e., clonidine and dexmedetomidine), and antipsychotic drug classes for management of adults in the ICU with severe TBI.


Intensive Care Unit Stay Cerebral Perfusion Pressure Severe Traumatic Brain Injury Severe Head Injury Sedative Agent 
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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • D. J. Roberts
  • D. A. Zygun

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