Critical patients can inspire fear in us and make us lose our focus on what we can do for them. We need to concentrate on our clinical examination of the patient to determine what the main problem areas are. We can then examine what we need to do with regard to stabilisation to allow sedation or anaesthesia for these critical patients: this is a major process in safe sedation/anaesthesia of these patients for imaging or surgery. We will then examine the pharmacological options available and develop some useful drug combinations too.