Pharmacology of Commonly Used Analgesics and Sedatives in the ICU: Benzodiazepines, Propofol, and Opioids

被引:87
作者
Devlin, John W. [1 ,2 ]
Roberts, Russel J. [1 ,2 ]
机构
[1] Northeastern Univ, Sch Pharm, Boston, MA 02115 USA
[2] Tufts Med Ctr, Boston, MA 02111 USA
关键词
Sedation; Analgesia; Critical care; Midazolam; Lorazepam; Propofol; Opioids; Fentanyl; INTENSIVE-CARE-UNIT; CRITICALLY-ILL PATIENTS; MECHANICALLY VENTILATED PATIENTS; POSTTRAUMATIC-STRESS-DISORDER; RANDOMIZED CONTROLLED-TRIAL; TERM CONTINUOUS-INFUSION; PROVIDE PATIENT COMFORT; PROPYLENE-GLYCOL; DOUBLE-BLIND; DAILY INTERRUPTION;
D O I
10.1016/j.ccc.2009.03.003
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Opioids, benzodiazepines, and propofol remain the mainstay by which to optimize patient comfort and facilitate mechanical ventilation in patients who are critically ill. Unfortunately none of these agents share all of the characteristics of the ideal sedative or analgesic agent: rapid onset, rapid recovery, a predictable dose response, a lack of drug accumulation, and no toxicity. To optimize care, critical care clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of these sedatives and analgesics.
引用
收藏
页码:431 / +
页数:20
相关论文
共 99 条
[1]  
AMREIN R, 1988, EUR J ANAESTH, P65
[2]  
ARMSTRONG PJ, 1986, ANESTH ANALG, V65, P536
[3]   PHARMACOKINETICS OF PROPOFOL DURING AND AFTER LONG-TERM CONTINUOUS INFUSION FOR MAINTENANCE OF SEDATION IN ICU PATIENTS [J].
BAILIE, GR ;
COCKSHOTT, ID ;
DOUGLAS, EJ ;
BOWLES, BJM .
BRITISH JOURNAL OF ANAESTHESIA, 1992, 68 (05) :486-491
[4]   Osmol gap as a surrogate marker for serum propylene glycol concentrations in patients receiving lorazepam for sedation [J].
Barnes, BJ ;
Gerst, C ;
Smith, JR ;
Terrell, AR ;
Mullins, ME .
PHARMACOTHERAPY, 2006, 26 (01) :23-33
[5]   Propofol dosing regimens for ICU sedation based upon an integrated pharmacokinetic-pharmacodynamic model [J].
Barr, J ;
Egan, TD ;
Sandoval, NF ;
Zomorodi, K ;
Cohane, C ;
Gambus, PL ;
Shafer, SL .
ANESTHESIOLOGY, 2001, 95 (02) :324-333
[6]   A double-blind, randomized comparison of IV lorazepam versus midazolam for sedation of ICU patients via a pharmacologic model [J].
Barr, J ;
Zomorodi, K ;
Bertaccini, EJ ;
Shafer, SL ;
Geller, E .
ANESTHESIOLOGY, 2001, 95 (02) :286-298
[7]   OPTIMAL INTRAVENOUS DOSING STRATEGIES FOR SEDATIVES AND ANALGESICS IN THE INTENSIVE-CARE UNIT [J].
BARR, J ;
DONNER, A .
CRITICAL CARE CLINICS, 1995, 11 (04) :827-&
[8]   PROLONGED SEDATION DUE TO ACCUMULATION OF CONJUGATED METABOLITES OF MIDAZOLAM [J].
BAUER, TM ;
RITZ, R ;
HABERTHUR, C ;
HA, HR ;
HUNKELER, W ;
SLEIGHT, AJ ;
SCOLLOLAVIZZARI, G ;
HAEFELI, WE .
LANCET, 1995, 346 (8968) :145-147
[9]   Fatal propofol infusion syndrome in association with ketogenic diet [J].
Baumeister, FAM ;
Oberhoffer, R ;
Liebhaber, GM ;
Kunkel, J ;
Eberhardt, J ;
Holthausen, H ;
Peters, J .
NEUROPEDIATRICS, 2004, 35 (04) :250-252
[10]   Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain [J].
Benítez-Rosario, MA ;
Feria, M ;
Salinas-Martín, A ;
Martinez-Castillo, LP ;
Martin-Ortega, JJ .
CANCER, 2004, 101 (12) :2866-2873