Sedation and hemodynamics

In critically ill patients, several pathological conditions could impair hemodynamic function. However, even iatrogenic factors like sedative drugs, commonly administered to ensure comfort to patients, may contribute to deteriorate oxygen delivery (DO2) to organs. Providing adequate DO2 to tissues is the key point to improve the outcome of intensive care unit (ICU) patients. Intensivists should target precise levels of sedation to avoid oversedation, which could lead to arterial hypotension and tissue hypoperfusion. Opposite, undersedated patients may have arterial hypertension and arrhythmias due to the activation of the sympathetic nervous system. Individualized target of sedation, followed by periodically arousal monitoring, is the key to keep hemodynamic stability. In this chapter we describe the impact that the main sedative agents have on the cardiovascular system. In addition, evidences in sedation practice from latest scientific literature are presented.