Response to Letter by Silva et al
We appreciate the comments of Dr Silva and colleagues clarifying that etomidate should be used as rapid induction for intubation rather than as a long-term sedative. We also concur that remifentanil is a useful medication for pain control/sedation. The published ASA Guidelines on Management of Spontaneous Intracerebral Hemorrhage were not meant to give a comprehensive review on each and every agent and its proper use in various settings but rather to briefly mention medications that are used for sedation and pain control in patients with intracerebral hemorrhage who require intubation and ventilation. There are excellent reviews elsewhere that describe detailed approaches to sedation and pain control in the neurocritical care setting. As far as we are aware, no specific randomized trials have been conducted that assess the benefits of one particular sedative or analgesic over another in patients with intracranial hemorrhages. This is a potential area of future research.