Sedation is an essential part of intensive care medicine. The most common agents used for sedation in intensive care units are midazolam or propofol in combination with opioids. This sedatives have short half-life times, rapid onset after application and a short duration depending on the dose that is given.
A small part of patients in our intensive care unit need long-term sedation. Most of this patients have multiple organ failure caused by septic shock or cardiac shock.
Short working sedatives are very expensive and a relevant economical factor in intensive care units.
Drugs used in long term sedation should be as safe and as comfortable for the patient as continuous given midazolam or propofol. Patients ventilated for two or more weeks often need some days to awake after discontinuation of sedation and they awake with discomfort from sedation with midazolam.
In long-term sedation we used phenobarbital in combination with fentanyl since more than 5 years in about 40 adult patients. After stabilisation of the patient we switch from continuous application of midazolam to bolus application of phenobarbital 200 mg given every 6–8 hours. A patient with 70 kg bodyweight needs about 1000 mg per day phenobarbital for a deep sedation. The level of sedation could be controlled easily. The Ramsey sedation scale should be used to measure the level of sedation. Plasma levels could be controlled. Phenobarbital is a safe drug and the patient are comfortable sedated. There is no significant decrease in blood pressure after bolus application. There is no prolongation of sedation in contrast to continuous given midazolam. All patients waked up comfortable.
Cost of sedation with midazolam 240 mg/day (10 mg/h): 85 Euro/day. Cost of sedation with Phenobarbital 1000 mg/day: 6.2 Euro/day. Phenobarbital has an important cost-benefit.
Phenobarbital is a recommendable drug for long-term sedation.