Are you guys doing this? I am an anesthesiologist rotating in the MICU and this is what I am seeing. Patients on 200-300mcg/hr of Fentanyl or Dilaudid 3-5mg/hr IV before propofol/precedex. And attendings are like "treat pain first" before adding sedation drugs. So on top of the drips, there are pushes. I guess this is en vogue since "pain" is the fifth VS and all that jazz, but really, why are these patients needing such large doses of narcotics? For the ETT pain? Is it really that uncomfortable? In the SICU and NICU we are still old school I and running propofol/precedex first and adding Fentanyl and Dilaudid for pain if there's a known surgical/pain issue. And our Fentanyl drips rarely go above 100mcg/hr. Personally, I am not buying into the whole, narcotics first in medical patients without a known pain issue because I think it's creating tolerance, withdrawal, possible neuroexitation, and probably other things that we have yet to research and figure out. Especially when it's most likely unnecessary. Yes, there are papers, but we all know how research changes over time when we discover we are harming patients. Has the pendulum swung too far? What do y'all think?