For moderate FAS, what combination is commonly used?

• A. Ketamine with benzodiazepine
• B. An opioid added to an alpha-2 agonist
• C. NSAIDs only
• D. Monotherapy with an opioid

Answer: (B)

The best approach for moderate FAS is using a combination of an opioid and an alpha-2 agonist. This multimodal pairing provides both sedation and analgesia, with a synergistic effect that allows using lower doses of each drug. The alpha-2 agonist contributes calmness, reduced anxiety, some analgesia, and muscle relaxation, while the opioid addresses both visceral and somatic pain, giving more robust pain control and a smoother, calmer experience for the patient.

Relying on NSAIDs alone won’t produce the needed sedative effects for moderate FAS and may miss the immediate analgesia required during handling or procedures. Using only an opioid may give analgesia but not sufficient sedation or anxiolysis. Ketamine with benzodiazepine is a different induction/maintenance strategy rather than the typical moderate-sedation plan, so it’s not the usual choice for moderate FAS.