Adverse Events Associated with Sedatives, Analgesics, and Other Drugs That Provide Patient Comfort in the Intensive Care Unit

Riker, Richard R.; Fraser, Gilles L.

doi:10.1592/phco.2005.25.5_part_2.8s

Cited by 134 publications

(75 citation statements)

References 124 publications

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“…Even if these 2 medications are carefully titrated, active metabolites (ie, morphine-6-glucuronide and hydroxymidazolam) can prolong the sedative effect and lead to oversedation. 3,57,58 On the other hand, clinicians may think patients are heavily sedated when the patients actually are sleeping. Without complicated monitoring of sedated patients receiving mechanical ventilation, distinguishing sleep from oversedation or sudden neurological dysfunction may be difficult.…”

Section: Discussionmentioning

confidence: 99%

“…However, sedatives administered for comfort may have prolonged and adverse effects, including increased requirements for mechanical ventilation, increased ICU length of stay, increased risk of infection, adverse neurocognitive effects, and increased risk of mortality. 3,4 Therefore, the doses of sedatives and analgesics administered to critically ill patients must be vigilantly monitored to optimize patients' tolerance to treatment and minimize the length of time that invasive support is required.…”

Section: Survey Testingmentioning

confidence: 99%

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Sedation Management in Australian and New Zealand Intensive Care Units: Doctors’ and Nurses’ Practices and Opinions

O’Connor

Bucknall

Manias

2010

American Journal of Critical Care

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Objective To explore the use of sedatives and analgesics, tools for scoring level of sedation, sedation and pain protocols, and daily interruptions in sedation in Australian and New Zealand intensive care units and to examine doctors' and nurses' opinions about the sedation management of critically ill patients. Methods A cross-sectional Internet-based survey design was used. In total, 2146 members of professional critical care organizations in Australia and New Zealand were e-mailed the survey during a 4-month period in 2006 through 2007. Results Of 348 members (16% response rate) who accessed the survey, 246 (71%) completed all sections. Morphine, fentanyl, midazolam, and propofol were the most commonly used medicines. Newer medicines, such as dexmedetomidine and remifentanil, and inhalant medications, such as nitrous oxide and isoflurane, were rarely used by most respondents. Respondents used protocols to manage sedatives (54%) and analgesics (51%), and sedation assessment tools were regularly used by 72%. A total of 62% reported daily interruption of sedation; 23% used daily interruption for more than 75% of patients. A disparity was evident between respondents' opinions on how deeply patients were usually sedated in practice and how deeply patients should ideally be sedated. Conclusions Newer medications are used much less than are traditional sedatives and analgesics. Sedation protocols are increasingly used in Australasia, despite equivocal evidence supporting their use. Similarly, daily interruption of sedation is common in management of patients receiving mechanical ventilation. Research is needed to explore contextual and personal factors that may affect sedation management.

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Section: Discussionmentioning

confidence: 99%

Section: Survey Testingmentioning

confidence: 99%

Sedation Management in Australian and New Zealand Intensive Care Units: Doctors’ and Nurses’ Practices and Opinions

O’Connor

Bucknall

Manias

2010

American Journal of Critical Care

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“…Kako je lek rastvoren u 10% lipidnoj emulziji, koja sadrži sojino ulje i lecitin jajeta, dugotrajna infuzija propofola može da uzrokuje značajno lipidno opterećenje i hipertrigliceridemiju. Opisan je i nastanak akutnog pankreatitisa 27 . Jedan od najtežih neželjenih efekata je razvoj propofolskog infuzionog sindroma (PRIS), koji se odlikuje progresivnom metaboličkom acidozom, hipertrigliceridemijom, hipotenzijom i malignim aritmijama.…”

Section: Propofolunclassified

Sedation in intensive care units

Veličković¹,

Palibrk²

2018

Serb J Anest Inten Therapy

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“…Poiché però i lipidi aumentano il rischio di infezioni, le infusioni di propofol devono essere maneggiate con tecniche asettiche. Un motivo comune per l'interruzione del trattamento con propofol è l'aumento del livello dei trigliceridi [1,24]. Midazolam ha una rapida insorgenza e breve durata di azione, con somministrazione di una dose singola.…”

Section: Dexmedetomidina Nella Sedazione Dei Pazienti In Unità DI Terunclassified

The use of dexmedetomidine in intensive care sedation

Antonelli

Conti

Belisari³

et al. 2013

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The goals and recommendations for ICU (Intensive Care Unit) patients’ sedation and analgesia should be to have adequately sedated patients who are calm and arousal, so that they can guarantee a proper evaluation and an adequate control of pain. This way, it is also possible to perform their neurological evaluation, preserving intellectual faculties and helping them in actively participating to their care. Dexmedetomidine is a selective alpha-2 receptor agonist, member of theraputical cathegory: “other hypnotics and sedatives” (ATC: N05CM18). Dexmedetomidine is recommended for the sedation of adult ICU patients who need a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale 0 to -3). After the EMA approval, some European government authorities have elaborated HTA on dexmedetomidine, based on clinical evidence derived from Prodex and Midex trials. Dexmedetomidine resulted to be as effective as propofol and midazolam in maintaining the target depth of sedation in ICU patients. The mean duration of mechanical ventilation with dexmedetomidine was numerically shorter than with propofol and significantly shorter than with midazolam. The resulting favourable economic profile of dexmedetomidine supported the clinical use in ICU. Dexmedetomidine seems to provide clinical benefits due to the reduction of mechanical ventilation and ventilator weaning duration. Within the present review, an economic analysis of costs associated to the use of dexmedetomidine was therefore performed also in the Italian care setting. Thus, four different analyses were carried out based on the quantification of the total number of days in ICU, the time spent on mechanical ventilation, the weighted average number of days with mechanical ventilation or not and TISS points (Therapeutic Intervention Scoring System). Despite the incremental cost for drug therapy associated with dexmedetomidine, a reduction of the management costs for ICU has been estimated, with savings ranging between € 800 and € 1,400 per patient.

http://dx.doi.org/10.7175/fe.v14i1S.674

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Adverse Events Associated with Sedatives, Analgesics, and Other Drugs That Provide Patient Comfort in the Intensive Care Unit

Cited by 134 publications

References 124 publications

Sedation Management in Australian and New Zealand Intensive Care Units: Doctors’ and Nurses’ Practices and Opinions

Sedation Management in Australian and New Zealand Intensive Care Units: Doctors’ and Nurses’ Practices and Opinions

Sedation in intensive care units

The use of dexmedetomidine in intensive care sedation

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