A still body can hide a restless mind. We take you inside the judgment calls that separate safe care from silent suffering, breaking down why sedation must come before paralysis, how to pick the right agent for the job, and what real monitoring looks like when movement disappears. 

Featuring CSPA faculty coach and Assistant Program Director at the University of Evansville Dr. Matthew Harmon, DNP, CRNA, tune in as we map the core properties of propofol, midazolam, ketamine, and dexmedetomidine, explaining where each shines, where they fall short, and how to combine them for ventilator tolerance, alcohol withdrawal, and smoother wake-ups.

From there, we get precise with neuromuscular blockade. Succinylcholine’s speed comes with serious risks—hyperkalemia, myalgias, malignant hyperthermia—while rocuronium offers rapid onset with the safety net of sugammadex for true reversal. Cisatracurium’s Hofmann elimination makes it the ICU favorite when organ failure limits options. We walk through high-yield RSI pairings for unstable patients, asthmatics, and trauma, emphasizing hemodynamic stability and airway planning with backup routes before giving the first dose.

Monitoring ties it all together. Learn how to set RASS targets, use BIS thoughtfully, interpret autonomic red flags like tachycardia and lacrimation, and titrate train-of-four to match goals in the ICU versus the OR. We also cover reversal pitfalls—flumazenil in benzodiazepine dependence, naloxone’s catecholamine surge—and share practical tips on IV integrity, ventilator settings, and post-intubation stabilization. If you’re preparing for CRNA school or refining ICU practice, this is a clear, actionable roadmap to safer sedation, smarter paralysis, and better outcomes at the bedside.

If this helped sharpen your practice, follow the show, share it with a colleague, and leave a review so more ICU nurses and future CRNAs can find it.

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