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

@article{Brotherton2016PropofolFT,
  title={Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature},
  author={Amy L. Brotherton and Eric P. Hamilton and H. Grace Kloss and Drayton A. Hammond},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
  year={2016},
  volume={36}
}
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… 
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TLDR
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TLDR
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TLDR
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TLDR
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TLDR
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References

SHOWING 1-10 OF 51 REFERENCES
Use of Propofol-Containing Versus Benzodiazepine Regimens for Alcohol Withdrawal Requiring Mechanical Ventilation
TLDR
Propofol and Benzodiazepine-treated patients with AWS requiring mechanical ventilation experienced similar days of AWS symptoms, length of stay, and mechanical ventilation.
Dexmedetomidine for the Treatment of Alcohol Withdrawal Syndrome: Rationale and Current Status of Research
TLDR
Based on a limited body of evidence, dexmedetomidine shows promise as a potentially safe and possibly effective adjuvant treatment for AWS in the ICU, and prospective, well-controlled studies are needed to confirm the safety and efficacy of the use of the drug in AWS.
Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens.
TLDR
This study suggests that treatment with propofol is viable in refractory delirium tremens, and establishing indication, dose, duration, and long-term effects of prop ofol treatment of deliria tremens requires further investigation.
Clinical management of alcohol withdrawal: A systematic review
TLDR
Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity.
Alcohol withdrawal and delirium tremens in the critically ill: a systematic review and commentary
TLDR
Treatment of AWS is associated with higher ICU complication rates and resource utilization, and early and aggressive titration of medication guided by symptoms is the only feature associated with improved treatment outcome.
Response to “Benzodiazepine misadventure in acute alcohol withdrawal: the transition from delirium tremens to ICU delirium”
TLDR
In this retrospective case series, the use of dexmedetomidine is reported for treatment of alcohol withdrawal syndrome (AWS), to avoid mechanical ventilation, and it is broadened to other withdrawal syndromes, including benzodiazepines, opioids, and cocaine.
Evaluating the effects of dexmedetomidine compared to propofol as adjunctive therapy in patients with alcohol withdrawal
TLDR
Both agents appear to have equivalent efficacy in reducing AW-related symptoms and benzodiazepine and haloperidol requirements, and both dexmedetomidine and propofol have unique and advantageous properties.
Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU
TLDR
This observational study suggests that dexmedetomidine therapy for severe alcohol withdrawal is associated with substantially reduced benzodiazepine dosing, a decrease in alcohol withdrawal scoring and blunted hyperadrenergic cardiovascular response to ethanol abstinence.
Benzodiazepine misadventure in acute alcohol withdrawal: the transition from delirium tremens to ICU delirium
TLDR
A case of severe alcohol withdrawal transitioning to ICU delirium following extensive benzodiazepine exposure is encountered, illustrating the potential complications of Benzodiazepines in severealcohol withdrawal.
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