Can a stroke patient be given sedatives?

A fellow caregiver asked...

My father had a major hemorrhage stroke 2 weeks ago (in the occipital part of the brain) and he gets very anxious at night. He is ringing up getting my mother, brother and I to go to the hospital at 12.30 am and we were wondering if a sedative could be prescribed to relax him and stop his nightly anxiety attacks, or if there is some reason why stroke patients cannot be given a sedative. His doctor says he is doing quite well however, dad has one paralysed leg which needs to be working before he can come home, but his physiotherapist said there is quite a lot of strength in the leg and is happy with him. Your thoughts on this would be appreciated. Sandra

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Sandra, the short answer to your question is, yes, but with caution.

It is very common for older patients to get confused when they are in the hospital. This is particularly true at night, when the brain is not functioning at peak performance (true of anyone). I have routinely seen patients who start making accusatory statements towards the nurses, or who think that they are being kept against their will, at night. During the day, they are much calmer and happier.

Worse yet is if a patient has suffered a stroke, further worsening their brain function. Confusion becomes quite common in this group.

In general, if the patient can be calmed with environmental cues, this is better than medicine. Often, this requires the help of a family member. Nurses and staff members are frequently not trusted by a confused patient, but a friendly and familiar face will be.

I reserve sedative medicines only for those who might harm themselves, such as by falling out of bed, pulling out IV lines, pulling out feeding tubes, etc. In those cases, best to give low doses of medicines that will be out of the system by morning, so that the patient can participate in rehabiliation. Best not to oversedate, or your father will not be able to get the rehab he needs. Also, there is a theoretical risk of sedating him to the point that medical staff would be unable to evaluate any neurological changes adequately (important to track after a stroke).

I hope that helps. Good luck!