A 17-yr-old male sustained 90% flame burn injury requiring mechanical ventilation, multiple surgeries and anesthetics. The graph indicates the mg/kg/hr doses of morphine and midazolam administered over time after burn starting from week 1 to week 25. At one stage the intravenous morphine and midazolam doses required exceeded 55mg/hr of each. During procedures (e.g., dressing changes) additional doses of ketamine, dexmedetomidine, fentanyl, and/or propofol were administered pro re nata (PRN). Morerecently, when the doses of morphine and midazolam exceeds 0.5mg/kg/hr, we institute dexmedetomidine or ketamine infusions as sedative and change the opioid from morphine to fentanyl or vice versa (See also table 5)