Given the nature of combat injuries and the environment of care, both agitation and anxiety can be expected and should be preemptively managed. In a patient with normal hemodynamics, propofol is a good option for short-term sedation. Propofol does not provide analgesia; it is the most commonly used medication when sedation is required for ICU patients and CCAT transports due to its rapid onset and clearance. It is a gamma-aminobutyric acid agonist with rapid onset and clearance. Propofol can cause hypotension and should be used with caution in patients with intravascular depletion. Propofol is dissolved in a 10% lipid solution. It is an excellent drug for ICU patients scheduled to undergo aeromedical evacuation. Propofol should only be administered to patients who have a definitive airway (endotracheal tube, tracheostomy), are hemodynamically stable and are continuously monitored by trained personnel.4,25,26

Dexmedetomidine is being used with increasing frequency in ICU patients and occasionally for transport. It minimally decreases respiration, so it can be used for patients on non-invasive mechanical ventilation or sedation for an awake intubation. It has some mild analgesic effects. It should be used with caution in patients with bradycardia or heart block. Dexmedetomidine is a relatively selective alpha-2 agonist; it is a good option for short-term sedation and anxiolysis. Dexmedetomidine has minimal impact on respiratory drive allows for ongoing assessment of the patient’s mental status.4

Clonidine is an effective drug for treating patients with anxiety and agitation; it is particularly effective for patients with hypertension associated with agitation.5,27 Clonidine acts as an alpha-2 adrenergic agonist and also has sedative properties that do not result in respiratory suppression. It may also be used for mild sedation and analgesia.27