Sedatives and analgesics are routinely used in the intensive care unit to relieve pain and anxiety. These agents have numerous side effects and may contribute to poor outcomes such as increased length of mechanical ventilation, longer ICU stays and acute and long-term cognitive dysfunction. Modifying sedation paradigms utilizing either narcotic-based regimens with remifentanil or fentanyl, or by using alpha2 agonists such as dexmedetomidine may help in improving these outcomes in critically ill patients.