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Review
. 2025 Apr 11;17(4):e82074.
doi: 10.7759/cureus.82074. eCollection 2025 Apr.

The Role of Anesthesia in Sedation and Weaning From Mechanical Ventilation: A Systematic Review

Majed M Madkhali  1 , Manssour M Alfaifi  2 , Abdulrahman Y Safhi  3 , Yasser M Shmakhi  4 , Arwa H Alammari  3 , Majed M Qaysi  3 , Amaal A Hamdi  3 , Saleha M Ayoub  3 , Shahad A Rajhi  3 , Roaa G Shaikhain  3 , Abdulrahman F Alsubaie  5 , Mohammed N Alazmi  6 , Rafa M Hadaddi  7
Affiliations
Review

The Role of Anesthesia in Sedation and Weaning From Mechanical Ventilation: A Systematic Review

Majed M Madkhali et al. Cureus. .

Abstract

Mechanical ventilation is a critical component of care in ICUs, yet its prolonged use can result in significant complications. Effective sedation strategies play a pivotal role in facilitating the discontinuation of mechanical ventilation and minimizing associated adverse outcomes. This systematic review evaluates the impact of anesthetic-based sedation methods on optimizing the process of weaning adult patients from mechanical ventilation in intensive care settings. A comprehensive literature search was conducted across major databases, including PubMed, Web of Science, Scopus, the Virtual Health Library, and Cochrane CENTRAL, up to March 10, 2024, following established systematic review guidelines. Eligible studies included randomized controlled trials and observational research comparing anesthetic agents with conventional sedation techniques, with outcomes such as weaning duration, extubation success, length of stay in the ICU, incidence of delirium, sedation quality, adverse events, and mortality. Study quality was assessed using a validated methodological checklist. Out of 1,649 records screened, five studies met the inclusion criteria. Results indicated that dexmedetomidine was associated with shorter weaning times and reduced anxiety, agitation, and delirium compared to traditional sedation. Sequential sedation protocols, particularly transitions from midazolam to dexmedetomidine, yielded improved clinical outcomes, while enteral methadone significantly reduced weaning duration compared to fentanyl. Despite higher daily costs, anesthetic agents demonstrated favorable economic outcomes due to shorter intensive care stays. These findings suggest that targeted anesthetic sedation strategies may enhance the weaning process and improve overall patient outcomes, underscoring the need for further large-scale studies to validate and standardize these approaches.

Keywords: anesthesia; critical care; dexmedetomidine; intensive care; mechanical ventilation; methadone; patient outcomes; sedation; sequential sedation; weaning.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flow diagram of the study selection process according to PRISMA guidelines
PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses
See this image and copyright information in PMC

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