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Use of Analgesics and Sedatives in Critical Care

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Abstract

Understand the pharmacokinetics and pharmacodynamics of various sedative/hypnotics and analgesics. Be aware of the action of sedative/hypnotics and analgesics on central γ-aminobutyric acid (GABA) and opioid receptor systems. Understand the need for routine and effective sedation and analgesia in the critically ill patient. Make recommendations regarding the choice and appropriate dose of sedative/hypnotics and analgesics in the critically ill. Recognize that agitation has multiple etiologies and should be investigated as fully as possible prior to treatment. Recognize that agitated patients could pose danger to themselves and/or healthcare personnel, and pharmacologic intervention may be necessary to facilitate safe patient care.

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Additional Reading

  • Cammarano WB, Pittet JF, Weitz S, et al. Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Crit Care Med. 1998;26:676-684.

    Article  PubMed  CAS  Google Scholar 

  • Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth. 1995;42:891-903.

    Article  PubMed  CAS  Google Scholar 

  • Devlin JW, Boleski G, Mlynarek M, et al. Motor activity assessment scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med. 1999;27:1271-1275.

    Article  PubMed  CAS  Google Scholar 

  • Marinella MA. Propofol for sedation in the intensive care unit: essentials for the clinician. Respir Med. 1997;91:505-510.

    Article  PubMed  CAS  Google Scholar 

  • Morgan D, Cook CD, Smith MA, Picker MJ. An examination of the interactions between the antinociceptive effects of morphine and various opioids: the role of intrinsic efficacy and stimulus intensity. Anesth Analg. 1999;88:407-413.

    PubMed  CAS  Google Scholar 

  • Pasternak GW. Pharmacological mechanisms of opioid analgesics. Clin Neuropharmacol. 1993;16:1-18.

    Article  PubMed  CAS  Google Scholar 

  • Shapiro B, Warren J, Egol A, et al. Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Crit Care Med. 1995;23:1596-1600.

    Article  PubMed  CAS  Google Scholar 

  • Wagner BKJ, O’Hara DA. Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients. Clin Pharmacokinet. 1997;33:426-453.

    Article  PubMed  CAS  Google Scholar 

  • Wagner BKJ, Zavotsky KE, Sweeney JB, Palmeri BA, Hammond JS. Patient recall of therapeutic paralysis in a surgical critical care unit. Pharmacotherapy. 1998;18:358-363.

    PubMed  CAS  Google Scholar 

  • Wang JJ, Tai S, Lee ST, Liu YC. A comparison among nalbuphine, meperidine and placebo for treating postanesthetic shivering. Anesth Analg. 1999;88:686-689.

    PubMed  CAS  Google Scholar 

  • Watling SM, Dasta JF, Seidl EC. Sedatives, analgesics, and paralytics in the ICU. Ann Pharmacother. 1997;31:148-153.

    PubMed  CAS  Google Scholar 

  • Zorumski CF, Isenberg KE. Insights into the structure and function of GABA-benzodiazepine receptors: ion channels and psychiatry. Am J Psychiatry. 1991;148:162-173.

    PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Temple University School of Medicine, Philadelphia, PA, 19140, USA

    Rodger E. Barnette MD, FCCM & David Y. Kim MD

  2. Department of Anesthesiology and Critical Care Medicine, University of South Florida/College of Medicine, Tampa General Hospital, Tampa, FL, 33606, USA

    John W. Schweiger MD, FCCP

  3. Pulmonary and Critical Care Medicine and Temple Lung Center, Temple University School of Medicine, Philadelphia, PA, 19140, USA

    Gerard J. Criner MD

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  1. Rodger E. Barnette MD, FCCM
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  2. David Y. Kim MD
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  3. John W. Schweiger MD, FCCP
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  4. Gerard J. Criner MD
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Editors and Affiliations

  1. School of Medicine, Temple University, N. Broad St. 3420, Philadelphia, 19140, USA

    Gerard J. Criner

  2. Dept. Medicine, Temple University, N. Broad Street 3401, Philadelphia, 19140, USA

    Rodger E. Barnette

  3. School of Medicine, Temple University, N. Broad St. 3420, Philadelphia, 19140, USA

    Gilbert E. D'Alonzo

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Barnette, R.E., Kim, D.Y., Schweiger, J.W., Criner, G.J. (2010). Use of Analgesics and Sedatives in Critical Care. In: Criner, G., Barnette, R., D'Alonzo, G. (eds) Critical Care Study Guide. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77452-7_57

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