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Safe Duration of Sedation

Sedation depresses patients’ awareness of the environment and reduces their responsiveness to stimulation from the outside world [1]. As a result, sedation is a beneficial tool during surgical operations and for the treatment of critically ill patients in the intensive care unit (ICU). However, this state carries risks that justify minimizing the duration of sedation whenever possible to lower the chances of complications. This article will explore the risks of prolonged sedation and offer strategies for minimizing its duration to within safe limits. 

Long-term, continuous sedation can expose critically ill patients placed on mechanical ventilation to various risks. For instance, researchers have identified an association between total continuous sedation and prolonged ICU stay, diminished ability to assess mental status, increased risk of delirium, suppressed brainwave function, and increased length of intubation [2]. Other studies have revealed that prolonged sedation can result in tachypnea, tachycardia, extreme hypertension, organ system failure, and ventilation asynchrony [3]. Furthermore, limited data suggests a positive relationship between the length of sedation and the development of post-traumatic stress disorder and depression [3]. Because of all of these factors, it is unsurprising that ICU patients who experience continuous sedation have heightened rates of six-month mortality [2].  

Given the fact that 85% of ICU patients receive sedatives, and that these medications carry such significant risks, it is essential that practitioners reduce sedation duration to keep patients safe as much as possible while balancing the needs of patients’ conditions [4]. Of course, addressing these concerns is complicated by the many benefits of sedation, including reduced pain and anxiety, lowered stress, decreased oxygen consumption, and greater cooperation with mechanical ventilation [4]. 

To strike a balance, some researchers recommended engaging in daily sedation interruption (DSI), which may limit the duration of mechanical ventilation and, thus, the overall need for prolonged sedation [6]. However, one review compared critically ill, mechanically ventilated patients on DSI schedules with those receiving uninterrupted sedation and did not reveal significant differences between the two groups in terms of length of ICU or hospital stay, time spent on mechanical ventilation, quality of life, mortality, or complication rates [6]. Conversely, a study by Sharma et al. did identify an association between DSI and improved outcomes, suggesting the need for more research in this area [2]. Regardless, practitioners considering this strategy should prepare for the possibility that suppressing sedation carries risks of its own, including heightened sympathetic drive and laryngeal injury [2]. 

Safe duration of sedation during surgical procedures should also be considered. In some cases, the ideal length of sedation depends on the projected duration of the operation. For instance, longer lengths of sedation are appropriate for the majority of pediatric orthopedic reductions, which tend to be longer operations [7]. To control sedation duration during surgery, medical teams should consider picking sedatives according to the speeds at which they act, as well as tailoring dosage to patients’ needs [8]. The effect of a single dose of a sedative can vary greatly between medications, with one dose of naloxone lasting for only about 30 to 45 minutes, while meperidine may endure anywhere from 2 to 4 hours [8]. For many procedures, evolving medical opinion is that shorter (and ideally less invasive) protocols are safer for patients. 

In summary, prolonged sedation is risky and, should be avoided or reduced when possible. Practitioners should adjust their practices, such as by using daily sedation interruption for critically ill patients or choosing a particular drug according to its duration for surgical patients, to promote the best possible outcomes. 


[1] A. M. Lingappan, “Sedation,” Medscape, Updated April 5, 2021. [Online]. Available:  

[2] S. Sharma, M. F. Hashmi, and D. J. Valentino III, “Sedation Vacation in the ICU,” StatPearls, Updated September 18, 2021. [Online]. Available:  

[3] W. D. Schweickert and J. P. Kress, “Strategies to optimize analgesia and sedation,” Critical Care, vol. 12, supp. 3, May 2008. [Online]. Available:  

[4] N. Temesgen et al., “Adult sedation and analgesia in a resource limited intensive care unit – A Systematic Review and evidence based guideline,” Annals of Medicine & Surgery, vol. 66, April 2021. [Online]. Available:

[5] C. G. Hughes, S. McGrane, and P. P. Pandharipande, “Sedation in the intensive care setting,” Clinical Pharmacology, vol. 4, p. 53-63, October 2012. [Online]. Available:  

[6] L. Burry et al., “Daily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasive mechanical ventilation,” Cochrane Database of Systematic Reviews, vol. 7, July 2014. [Online]. Available:

[7] N. Kannikeswaran et al., “Optimal dosing of intravenous ketamine for procedural sedation in children in the ED—a randomized controlled trial,” The American Journal of Emergency Medicine, vol. 34, no. 8, p. 1347-1353, August 2016. [Online]. Available:  

[8] S. Amorynyotin, “Sedation and monitoring for gastrointestinal endoscopy,” World Journal of Gastrointestinal Endoscopy, vol. 5, no. 2, p. 47-55, February 2013. [Online]. Available: