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Use of Analgesics and Sedatives in Critical Care

  • Rodger E. Barnette
  • David Y. Kim
  • John W. Schweiger
  • Gerard J. Criner
Chapter

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.

Keywords

Intensive Care Unit Respiratory Depression Gaba Receptor Neuroleptic Malignant Syndrome Inverse Agonist 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Additional Reading

  1. 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.PubMedCrossRefGoogle Scholar
  2. Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth. 1995;42:891-903.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. Marinella MA. Propofol for sedation in the intensive care unit: essentials for the clinician. Respir Med. 1997;91:505-510.PubMedCrossRefGoogle Scholar
  5. 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.PubMedGoogle Scholar
  6. Pasternak GW. Pharmacological mechanisms of opioid analgesics. Clin Neuropharmacol. 1993;16:1-18.PubMedCrossRefGoogle Scholar
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  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. 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.PubMedGoogle Scholar
  11. Watling SM, Dasta JF, Seidl EC. Sedatives, analgesics, and paralytics in the ICU. Ann Pharmacother. 1997;31:148-153.PubMedGoogle Scholar
  12. 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.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Rodger E. Barnette
    • 1
  • David Y. Kim
    • 1
  • John W. Schweiger
    • 2
  • Gerard J. Criner
    • 3
  1. 1.Department of AnesthesiologyTemple University School of MedicinePhiladelphiaUSA
  2. 2.Department of Anesthesiology and Critical Care MedicineUniversity of South Florida/College of Medicine, Tampa General HospitalTampaUSA
  3. 3.Pulmonary and Critical Care Medicine and Temple Lung CenterTemple University School of MedicinePhiladelphiaUSA

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