If the patient has a sedation score of <-1 on MMAAS, among any of the scheduled or intermittent assessments, the Midazolam infusion will be decreased by 0.05 mg/kg/hr and the patient will be reassessed in two hours. If there is no Midazolam infusion then, the Fentanyl infusion will be decreased by 0.5mcg/kg/hr and the patient will be reassessed in two hours. If the patient continues to have pain score of <-1 on repeat MMAAS then the Fentanyl or Midazolam continuous infusion will again be decreased as denoted above. The patient will again be reassessed in two hours. If the patient continues to have MMAAS score of <-1 a physician will be notified for assessment and intervention. If repeat MMAAS score >+1 then Fentanyl infusion will be increased and noted above and the patient will be reassessed in 30 min. If second repeat MMAAS not between +1 and –1 then a physician will be notified for assessment and intervention. If at any time MMAAS score between +1 and –1 then MMAAS will be repeated per protocol. If following first decrease in infusion and repeat MMAAS score >+1 then infusion previous adjusted will be increased to prior dose. The patient will be reassessed in 30 minutes. If repeat MMAAS score >+1 with hypertension/tachycardia then Fentanyl infusion will be increased as noted above. If MMAAS score >+1 and not hypertension/tachycardia then Midazolam infusion will be increases as noted above. After intervention MMAAS will be repeated in 30 minutes. If repeat MMAAS score remains >+1 then a physician will be notified for assessment and intervention (see figure 3).