Future Directions in Sedation and Analgesia.

The evolution of sedation in intensive care is complex but can help guide expectations of what the future might bring. Sedation and analgesia together with delirium prevention and treatment have evolved in lock step. Longer-acting drugs like lorazepam have been replaced with shorter-acting agents like propofol. Dexmedetomidine has become a frequent treatment of delirium. Longer-acting opioids remain dominant. The target has become lighter sedation rather than deep sedation, but monitoring of sedation and pain remains imperfect and subjective. The future will likely bring the introduction of ultra-short-acting analgesic agents and the greater use of adjunctive dexmedetomidine.