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

  title={Adverse Events Associated with Sedatives, Analgesics, and Other Drugs That Provide Patient Comfort in the Intensive Care Unit},
  author={Richard R. Riker and Gilles L. Fraser},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
  • R. RikerG. Fraser
  • Published 1 May 2005
  • Medicine
  • Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Since the 2002 publication of multidisciplinary clinical practice guidelines for intensive care unit (ICU) sedation and analgesia, additional information regarding adverse drug events has been reported. Our understanding of the risks associated with these sedative and analgesic agents promises to improve outcomes by helping clinicians identify and respond to therapeutic misadventures sooner. This review focuses on many issues, including the potentially fatal consequences associated with the… 

Adverse drug events associated with the use of analgesics, sedatives, and antipsychotics in the intensive care unit

The most common and serious adverse drug events reported to occur with the use of sedatives, analgesics, and antipsychotics in the intensive care unit are reviewed; the pharmacokinetic, pharmacodynamic, and pharmacogenetic factors that can influence analgesic, sedative,and antipsychotic response and safety in the critically ill are highlighted; and strategies that can be used to minimize toxicity with these agents are identified.

Clinical application : the use of dexmedetomidine in intensive care sedation.

Dexmedetomidine has been demonstrated to be associated with both sedative and analgesic sparing effects, reduced delirium and agitation, minimal respiratory depression and predictable and desirable cardiovascular effects in the intensive care setting.

Economic evaluation of sustained sedation/analgesia in the intensive care unit

The cost parameters of intensive care unit sedation that are specific to the characteristics of commonly used sedatives and analgesics are reviewed, economic studies and cost models are evaluated, and practical recommendations for methods of cost containment are provided.

Role of dexmedetomidine in adults in the intensive care unit: an update.

In medical-surgical ICUs, dexmedetomidine may be a viable non-benzodiazepine option for patients with a need for light sedation and in cardiac surgery patients, DexmedetOMidine appears to offer no advantage over propofol as the initial sedative.

Sedation and analgesia in the intensive care unit: evaluating the role of dexmedetomidine.

PURPOSE A review highlighting the application of sedatives and analgesics in the intensive care unit (ICU) setting, with a focus on the use of dexmedetomidine, is presented. SUMMARY Relevant and

Editor’s Choice-The cardiovascular implications of sedatives in the cardiac intensive care unit

The use of common sedatives available in the endotracheally intubated critically ill patient and their clinical and cardiovascular effects are described and judicious strategies minimizing sedative use are associated with decreases in morbidity and mortality.

Serious Cardiovascular Adverse Events Reported with Intravenous Sedatives: A Retrospective Analysis of the MedWatch Adverse Event Reporting System

Serious cardiac adverse events account for nearly one-fifth of intravenous sedative Food and Drug Administration’s MedWatch Adverse Event Reporting System reports and appear to be associated with greater mortality than non-cardiac serious adverse events.

[Pain management].

Management of Pain, Agitation, and Delirium in Mechanically Ventilated Oncology Patients

Several resources have been combined to better assist clinicians on making sound decisions for keeping patients comfortable on the ventilator while recognizing the differences in treatment that may need to be employed due to these patients’ medical condition.



Bradycardia Associated with Intravenous Methadone Administered for Sedation in a Patient with Acute Respiratory Distress Syndrome

This case report demonstrates that caution is warranted when high dosages of methadone are administered because of its potential cardiac effects, and a 43–year‐old man with acute respiratory distress syndrome experienced bradycardia while receiving a continuous infusion of methamphetamineadone for sedation and mechanical ventilation management.

Use of oral clonidine for sedation in ventilated paediatric intensive care patients

Oral clonidine may be a safe and effective sedative in combination with morphine and lorazepam for young children with single-organ, respiratory failure and this agent may also exhibit opioid and benzodiazepine sparing effects in this patient group.

Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial [ISRCTN50308308]

Analgesia-based sedation with remifentanil permitted significantly faster and more predictable awakening for neurological assessment and had a similar adverse event and haemodynamic profile to those of hypnotic-based regimens when used in critically ill neuro-intensive care unit patients for up to 5 days.

Intensive care sedation: a review of current British practice

The use of neuromuscular blocking drugs and the indications for their use, the use of sedation policies and scoring systems, the influence of cost on drug choice, and theUse of propofol for sedation in paediatric patients are established.

Indications for the Use of Propofol in Electroconvulsive Therapy

Propofol may be a useful alternative to methohexital for the treatment of patients who have excessively long seizures and/or severe nausea and vomiting after ECT, more common among adolescents.

Olanzapine vs haloperidol: treating delirium in a critical care setting

Olanzapine is a safe alternative to haloperidol in delirious critical care patients, and may be of particular interest in patients in whom hal operidol is contraindicated.

Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions.

Despite ventilation and intubation, patients sedated with dexmedetomidine could be easily roused to cooperate with procedures (e.g. physiotherapy, radiology) without showing irritation.

Prolonged dexmedetomidine infusion as an adjunct in treating sedation-induced withdrawal.

  • A. Multz
  • Medicine
    Anesthesia and analgesia
  • 2003
A patient in whom a continuous infusion of dexmedetomidine was safely used for a week to help in averting frank withdrawal symptoms from an opioid and benzodiazepines is reported on.

Pharmacoeconomic assessment of propofol 2% used for prolonged sedation

The new propofol 2% preparation is an effective sedative agent and is safe because of the low frequency of associated hypertriglyceridemia and the shorter weaning time associated with the use of propofl 2% as compared with midazolam compensates for its elevated cost.

National Survey of the Use of Sedating Drugs, Neuromuscular Blocking Agents, and Reversal Agents in the Intensive Care Unit

The objectives of this study were to describe the sedative, neuromuscular blocking agents (NMBA) and reversal agents utilized in adult intensive care units across the United States and determine the