Cardiovascular Manifestations of Sedatives and Analgesics in the Critical Care Unit

Abstract

There are numerous sedatives and analgesics used in critical care medicine today; these medications are used on critically ill patients, many of whom have heart disease, including coronary artery disease or congestive heart failure. The purpose of this review is to recognize the effects of these medications on the heart. Studies that evaluated the effects of sedatives and analgesics on normal individuals or on those with heart disease were reviewed. Current choices for sustained sedation in the critically ill include the benzodiazepines, morphine, propofol, and etomidate. Each of these medications has their particular advantages and disadvantages. Benzodiazepines provide the greatest amnesia and cardiovascular safety but they can cause significant hypotension in the hemodynamically unstable patient. Morphine provides analgesia and cardioprotective activity after ischemia, although the large observational study CRUSADE showed increased mortality rate in those patients with non-ST segment elevation myocardial infarction who received morphine. Propofol is the most easily titratable drug with cardioprotective features, but its use must be accompanied with great attention to possible development of propofol infusion syndrome, which is a deadly disease, especially in patients with head injury and those with septic shock receiving vasopressors. Etomidate has a rapid onset effect and short period of action with great hemodynamic stability even in patients with shock and hypovolemia, but the incidence of adrenal insufficiency during infusion, not bolus doses, may cause deterioration in the circulatory stability. In conclusion, the sedatives and analgesics mentioned here have characteristics that give them a cardiovascular safety profile useful in critically ill patients. However, use of these drugs on an individual basis is dependent on each agent's safety and efficacy.

Propofol administration to the fetal–maternal unit reduces cardiac oxidative stress in preterm lambs subjected to prenatal asphyxia and cardiac arrest

“…This corresponds to data deriving from clinical trials in adult medicine. In these trials, it was shown that propofol is effective in patients with left ventricular dysfunction caused by sepsis or myocardial infarction (32,33). The occurrence of ROS, however, is not the only fatal step towards cardiogenic shock and multiorgan failure.…”

“…Therefore, it is important to identify therapeutic options which specifically target the right steps in the pathophysiological cascade. Propofol seems to be a very promising agent in that context (11,33,36), but still has to prove its effectiveness in the human neonatal population. One major concern in this respect is propofol infusion syndrome.…”

Anaesthesia of farmed fish: implications for welfare

“…GABA A receptor activation produces sedation and hypnosis, but limited analgesia and immobilisation (Grasshoff et al 2006). Etomidate is commonly used in human and veterinary medicine as a sedative and for inducing anaesthesia (Ching and Baum 2009;Darrouj et al 2009;Falk and Zed 2004;Sams et al 2008). One of the side effects of the drug in addition to respiratory and cardiovascular depression is suppression of adrenal steroidogenesis, thus leading to an inhibition of cortisol synthesis (Vanden Bossche et al 1984;Wagner et al 1984; man, cow and rat).…”

Additive effect of propofol and fentanyl precipitating cardiogenic shock

“…This hemodynamic deterioration sometimes leads to multiple organ failure in post operative period. [1] But there is no other diagnostic test to evaluate this emergency situation except a meticulous clinical observation of sustained hypotension with tissue hypoperfusion despite adequate left ventricular filling pressure and oliguria. The development of advanced technology in the line of treatment such as extracorporeal life support (ELS), a variation of cardiopulmonary bypass, can improve the outcomes of cardiogenic shock.…”