New ICU strategy skips sedatives, uses only painkillers after brain surgery

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion criteria 1. Age 18-85 years; 2. Admission to the ICU after neurosurgical craniotomy; 3. Anticipated ICU stay greater than 24 hours according to the treating team at ICU admission or screening; 4. The Richmond Agitation-Sedation Scale (RASS) score ≥ +1, indicating restlessness or agitation requiring clinical management; 5. RASS, the Critical Care Pain Observation Tool (CPOT), and neurological status can be assessed reliably enough for protocol monitoring. Exclusion criteria 1. Need for deep sedation or therapeutic coma, including (partial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2): PaO2/FiO2≤100 mmHg, neuromuscular blockade requiring unconsciousness, status epilepticus, mandatory immobility for surgical or procedural safety, severe traumatic brain injury and intracranial hypertension, therapeutic hypothermia and any clinical condition requiring RASS \< -2) \[15, 16\]; 2. Medullary lesion, brainstem condition, or other disorder associated with impaired respiratory drive in which opioid analgesia is judged unsafe by the treating physician \[17\]; 3. Inability to assess the RASS score or neurological status because of coma, severe aphasia, status epilepticus, severe cognitive dysfunction, schizophrenia, mania, or aother psychiatric or neurological condition that precludes reliable assessment.; 4. Use of sedatives or opioid analgesics ≥ 1 week before enrollment; 5. Expected ICU stay time less than or equal to 24 hours; 6. Delirium, alcohol withdrawal, active severe psychiatric illness, or ongoing antipsychotic therapy before enrolment; 7. Severe hepatic dysfunction (Child-Pugh grade C); 8. Renal failure requiring renal replacement therapy; 9. Need for major surgery during the ICU stay, except short bedside or minor procedures, such as lumbar puncture or ventricular drainage, etc.); 10. Known allergy or contraindication to remifentanil, morphine, midazolam, propofol, or other protocol medications; 11. Pregnancy or lactation; 12. Participation in another interventional clinical trial that could interfere with the study intervention or outcomes.; 13. Patient or legally authorized representative unwilling to participate; 14. Investigator judgment that inclusion is inappropriate because of a specific safety concern that is documented in the screening record.