Drug of choice for sedation of a patient in ICU is: September 2009, March 2013 (a)
**Core Concept**
The question requires the identification of the most suitable sedative agent for patients in the Intensive Care Unit (ICU). Sedation in the ICU aims to maintain patient comfort, reduce anxiety, and prevent recall of stressful events. The ideal sedative agent should have a rapid onset and offset of action, minimal respiratory depression, and be easily titratable.
**Why the Correct Answer is Right**
Propofol is a short-acting sedative-hypnotic agent that is commonly used for sedation in the ICU. It has a rapid onset and offset of action, which allows for easy titration and quick recovery from sedation. Propofol also has anti-emetic properties and reduces the incidence of ventilator-associated pneumonia. Its mechanism of action involves enhancing the activity of the inhibitory neurotransmitter GABA, resulting in sedation, hypnosis, and amnesia.
**Why Each Wrong Option is Incorrect**
**Option A:** Diazepam is a long-acting benzodiazepine with active metabolites, which can lead to prolonged sedation and accumulation of toxic metabolites.
**Option B:** Lorazepam is also a benzodiazepine, but it has active metabolites that can lead to prolonged sedation and is not as easily titratable as propofol.
**Option D:** Alprazolam is a benzodiazepine with a high first-pass metabolism, which limits its use in the ICU due to variable and unpredictable effects.
**Clinical Pearl / High-Yield Fact**
Propofol is often referred to as "infusion therapy" due to its common use for long-term sedation in the ICU. It can cause a rare but serious condition known as propofol infusion syndrome, characterized by rhabdomyolysis, metabolic acidosis, and cardiac arrest.
**✓ Correct Answer: C. Propofol**