Benzodiazepine misadventure in acute alcohol withdrawal: the transition from delirium tremens to ICU delirium

Johnson, Michael T.; Yamanaka, Travis T.; Fraidenburg, Dustin R.; Kane, Sean P.

doi:10.1007/s00540-012-1458-7

Cited by 9 publications

(7 citation statements)

References 3 publications

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“…Despite the advantages of benzodiazepine use in AWS, these drugs may be associated with oversedation, respiratory depression, and a transition to intensive care unit (ICU) delirium. 5,6 Adjunctive agents in the management of AWS are attractive in an effort to control symptoms and prevent the development of complications from benzodiazepine use.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine for Alcohol Withdrawal Syndrome

Linn

Loeser

2015

Ann Pharmacother

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Section: Introductionmentioning

confidence: 99%

Dexmedetomidine for Alcohol Withdrawal Syndrome

Linn

Loeser

2015

Ann Pharmacother

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“…На этом фоне наряду со снижением тяжести СОА отмечались гипотензия и брадикардия [71]. В случаях высоковероятной передозировки бензодиазепинов у пациентов с резистентным к бензодиазепинам СОА весьма высок риск угнетения дыхания, гипоксии, летального исхода [72,73].…”

Section: Perioperative Administration Of Patients With Alcoholic Depeunclassified

Perioperative administration of patients with alcoholic dependence clinical recommendations

Zabolotskikh¹,

Бутров²,

Горобец³

et al. 2018

Anesteziologiya I Reanimatologiya

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В клинических рекомендациях отражены современные подходы к ведению пациентов с алкогольной зависимостью, профилактике и терапии наиболее часто встречающихся осложнений: синдром отмены алкоголя, алкогольного делирия, инфекционных осложнений, а также определению риска их возникновения. Ключевые слова: алкогольная зависимость, синдром отмены алкоголя, алкогольный делирий, периоперационный период.

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“…In one study, a requirement of > 200 mg of intravenous (IV) diazepam within 3 hours in combination with continued abnormal vital signs was characterized as the defining criteria for BZD resistant alcohol withdrawal (RAW) . The inappropriate dose‐escalation of BZDs in patients with RAW can result in an increase in morbidity and mortality and severe side effects, including oversedation, ICU delirium, and respiratory depression . The early initiation of adjunctive agents may provide potential benefits when managing the symptoms of RAW while preventing the untoward effects from high doses of BZDs.…”

Section: Background and Objectivesmentioning

confidence: 99%

“…24 The inappropriate dose-escalation of BZDs in patients with RAW can result in an increase in morbidity and mortality and severe side effects, including oversedation, ICU delirium, and respiratory depression. 25,26 The early initiation of adjunctive agents may provide potential benefits when managing the symptoms of RAW while preventing the untoward effects from high doses of BZDs.…”

Section: Background and Objectivesmentioning

confidence: 99%

Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature

et al. 2016

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The authors evaluated all available evidence on the use of propofol as an adjuvant for the treatment of resistant alcohol withdrawal syndrome (AWS) in comparison to other therapies. A comprehensive PubMed search (1966-December 2015) was conducted using the search terms propofol, alcohol withdrawal, and drug therapy. Articles were cross-referenced for other citations. Clinical studies, case series, and case reports published in the English language assessing the use of propofol in adult patients for treatment of AWS were reviewed for inclusion. Propofol is a sedative-hypnotic that exerts its actions through agonism of GABAA receptors at a different binding site than benzodiazepines and reduces glutamatergic activity through N-methyl-d-aspartase (NMDA) receptor blockade. Dosages from 5 to 100 μg/kg/minute reduced AWS symptoms with frequent development of hypotension and requirement for mechanical ventilation. Patients on propofol often experienced longer durations of mechanical ventilation and length of stay, which may be attributed to more-resistant cases of AWS. When propofol was compared with dexmedetomidine as adjuncts in AWS, both agents showed similar benzodiazepine- and haloperidol-sparing effects. Dexmedetomidine was associated with more numerical rates of bradycardia, while propofol was associated with more numerical instances of hypotension. Dexmedetomidine was used more frequently in nonintubated patients. The available data assessing the utility of propofol for AWS exhibited significant heterogeneity. Propofol may be useful in a specific population of patients with AWS, limited to those who are not clinically responding to first-line therapy with benzodiazepines. Specifically, propofol should be considered in patients who are refractory to or not candidates for other adjuvant therapies, patients already requiring mechanical ventilation, or those with seizure activity or refractory delirium tremens. In severe, refractory AWS, adjuvant therapy with propofol may be considered but requires further research to recommend its use either preferentially or as monotherapy.

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Benzodiazepine misadventure in acute alcohol withdrawal: the transition from delirium tremens to ICU delirium

Cited by 9 publications

References 3 publications

Dexmedetomidine for Alcohol Withdrawal Syndrome

Dexmedetomidine for Alcohol Withdrawal Syndrome

Perioperative administration of patients with alcoholic dependence clinical recommendations

Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature

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