Neurocritical Care

which is undesirable in a patient with ongoing cerebral

vasospasm. Answer D is incorrect; although a blood

transfusion might theoretically increase oxygen-carry-

ing capacity to the brain (enhancing perfusion), a blood

transfusion may in fact cause a risk of cerebral vaso-

spasm. In addition, it is unlikely to affect ICP.

Answer: D

Answer D is correct because propofol is an almost-

ideal agent for sedation with its quick onset and offset

of activity and relative lack of dependence on organ

function for clearance; however, boluses and large dose

titrations should be avoided because of the risk of hypo-

tension. Answers A and C are incorrect; long-acting

sedating agents such as lorazepam and morphine are

undesirable in patients with a neurologic injury because

of their propensity to obscure the neurologic exami-

nation for prolonged periods. Answer B is incorrect;

midazolam (and other benzodiazepines) is associated

with increased delirium. In addition, midazolam may

accumulate when used for a prolonged period because

of its long context-sensitive half-life.