medigraphic.com
ISSN 2448-8909 (Print)

2010, Number 3

<< Back Next >>

Med Crit 2010; 24 (3)

Deletion syndrome secondary to the suspension of the sedo analgesia in those patients

Carrillo ER, Carrillo CJR, Carrillo CLD, Carrillo CCA

Language: Spanish
References: 68
Page: 132-137
PDF size: 161.89 Kb.


ABSTRACT

Achieving optimal sedation and analgesia of patients in the ICU requires not only that the choice of medication(s) be appropriate for the clinical setting but also that there are specific clinical endpoints for the agents used. It´s important to achieve and maintain optimal levels of sedation and analgesia while minimizing the risk of oversedation, infrasedation and side effects. Withdrawal syndrome secondary to discontinuing of benzodiacepines, opioids and propofol are frequent in the Intensive Care Unit and became a limiting factor in the recovery. Patients with withdrawal syndrome had significantly elevated hemodynamic, metabolic and respiratory demands Hypertension, tachycardia, fever and delirium are the principal manifestations. The alpha-2 adrenoreceptor agonists, like dexmedetomidine, decrease sympathetic outflow and noradrenergic activity and attenuate the symptoms of withdrawal. There are studies and consensus that have made recommendations for weaning benzodiacepines, opioids and propofol rates to prevent withdrawal.


REFERENCES

  1. Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30:119-141.

  2. Taylor D. Iatrogenic drug dependence: a problem in intensive care? Intensive Crit Care Nurs 1999;15:95-100.

  3. Puntillo K, Casella V, Reid M. Opioid and benzodiazepine tolerance and dependence: application of theory to critical practice. Heart Lung 1997;26:317-324.

  4. Robb ND, Hargrave SA. Tolerance to intravenous midazolam as a result of oral benzodiazepine therapy: a potential problem for the provision of conscious sedation in dentistry. Anesth Pain Control Dent 1993;2:94-97.

  5. Tobias JD. Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children. Crit Care Med 1999;27:2262-5.

  6. Fonsmark L, Rasmussen YH, Carl P. Ocurrence of with-drawal in critically ill sedated children. Crit Care Med 1999;27:196-199.

  7. Marx CM, Rosenberg DI, Ambuel B, et al. Pediatric intensive care sedation: survey of fellowship training programs. Pediatrics 1993; 91:369-378

  8. Lutfy K, Yoburn BC. The role of opioid receptor density in morphine tolerance. J Pharmacol Exp Ther 1991;256:575-580.

  9. Miller LG, Greenblatt DJ, Roy RB. Chronic benzodiacepine administration: Discontinuation syndrome is associated with upregulation of gamma-aminobutyric acid receptor complex binding and function. J Pharmacol Exp Ther 1988;246:177-182.

  10. Hovav E, Weinstock M. Temporal factors influencing the development of acute tolerance to opiates. J Pharmacol Exp Ther 1987;242:251-256.

  11. Tobias JD, Deshpande JK, Pietsh JB, et al. Pentobarbital sedation for patients in the pediatric intensive care unit. South Med J 1995;88:290-294.

  12. Trujillo KA, Akil H. Inhibition of morphine tolerance and dependence by the NMDA receptor antagonist MK-801. Science 1991;251:85-87.

  13. Rasmussen K, Fuller RW, Stockton ME, et al. NMDA receptor antagonists suppress behaviors, but not norepinephrine turnover or locus coeruleus unit activity induced by opiate withdrawal. Eur J Pharmacol 1991;197:9-16.

  14. McCarthy RJ, Kroin JS, Truman KJ, et al. Anticonceptive potentiation and attenuation of tolerance by intratecal co-infusion of magnesium sulfate and morphine in rats. Anesth Analg 1998;86:830-836.

  15. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptors agonist. Anesthesia 1999;54:146-165.

  16. Maze M, Scarfini C, Caveliere F. New agents for sedation in the intensive care unit. Crit Care Clin 2001;17:881-897.

  17. Reid K, Hayashi Y, Hsu J, et al. Chronic treatment with dexmedetomidine desensitize alpha-2 adrenergic signal transduction. Pharmacol Biochem Behav 1995;57:63-71.

  18. Levy AB. Delirium and seizures due to abrupt alprazolam withdrawal. J Clin Psychiatry 1984;45:38-39.

  19. Mellman TA, Uhde TW. Withdrawal syndrome with gradual tapering of alprazolam. Am J Psychiatry 1986;143:1464-1466.

  20. Freda JJ, Bush HL, Barie PS. Alprazolam withdrawal in a critically ill patient. Crit Care Med 1992;20:545-546.

  21. Sury MRJ, Billingham I, Russell GN, et al. Acute benzodiazepine withdrawal reaction in two children following discontinuation of sedation with midazolam. Ann Pharmacother 1993; 27:579-581.

  22. Fonsmark L, Rasmussen YH, Carl P. Occurence of with-drawal in critically ill sedated children. Crit Care Med 1999;27:196-199.

  23. Bergman I, Steeves M, Burckart G, et al. Reversible neurologic abnormalities associated with prolonged intravenous midazolam and fentanyl administration. J Pediatr 1991;119:644-649.

  24. van Engelen BGM, Gimbrere JS, Booy LH. Benzodiazepine withdrawal reaction in two children following discontinuation of sedation with midazolam. Ann Pharmacother 1993;27:579-581.

  25. Rosen DA, Rosen KR. Midazolam for sedation in the paediatric intensive care unit. Intensive Care Med 1991;17:15-19.

  26. Hantson P, Clemesssy J, Baud F. Withdrawal syndrome following midazolam infusion. Intensive Care Med 1995;21:190-191.

  27. Finley PR, Nolan Jr PE. Precipitation of benzodiazepine withdrawal following sudden discontinuation of midazolam. DICP 1989;23:151-154.

  28. Mirenda J, Broyles G. Propofol as used for sedation in the ICU. Chest 1995;108:539-548.

  29. Fulton B, Sorkin EM. Propofol: an overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs 1995;50:636-657.

  30. Cawley MJ, Guse TM, Laroia A, et al. Propofol withdrawal syndrome in an adult patient in thermal injury. Pharmacotherapy 2003;23:933-9.

  31. Buckley PM. Propofol in patients needing long-term sedation in intensive care: an assessment of the development of tolerance. A pilot study. Intensive Care Med 1997;23:969-74.

  32. Boyle WA, Shear JM, White PF, et al. Tolerance and hyperlipemia during long-term sedation with propofol. Anesthesiology 1990;73:A245.

  33. Setlock M, Palmisano B, Berens RJ, Rosners DR, Troshynski TJ, Murray DJ. Tolerance does not develop to propofol used repeatedly for radiation. Anesthesiology 1996;85:207-209.

  34. Setlock MA, Palmisano BW, Berens RJ, et al. Tolerance to propofol generally does not develop in pediatric patients undergoing radiation therapy. Anesthesiology 1996;85:207-9.

  35. Mayhew JF, Abouleish AE. Lack of tolerance to propofol. Anesthesiology 1996;85:1209.

  36. Valente JF, Anderson GL, Branson RD, et al. Disadvantages of prolonged propofol sedation in the critical care unit. Crit Care Med 1994;22:710-2.

  37. Au J, Walker WS, Scott DHT. Withdrawal syndrome after propofol infusion. Anesthesia 1990;45:741-2.

  38. Victory RA, Magee D. A case of convulsion after propofol anaesthesia. Anaesthesia 1988;43:904.

  39. Imray JM, Hay A. Withdrawal syndrome after propofol. Anaesthesia 1991;46:704.

  40. Walder B, Tramer MR, Seeck M. Seizure-like phenomena and propofol. Neurology 2002;58:1327-32.

  41. Tobias JD. Opioid withdrawal presenting as stridor. J Intensive Care Med 1997;12:104-106.

  42. Lane JC, Tennison MB, Lawless ST, et al. Movement disorder after the withdrawal of fentanyl infusion. J Pediatr 1991;119:644-649.

  43. Katz R, Kelly HW. Pharmacokinetics of continuous infusion of fentanyl in critically ill children. Crit Care Med 1993;21:995-1000.

  44. Katz R, Kelly W, His A. Prospective study on the occurrence of withdrawal in critically ill children who received fentanyl by continuous infusion. Crit Care Med 1994;22:763-767.

  45. Anand KJS, Arnold JH. Opioid tolerance and dependence in infants and children. Crit Care Med 1994;22:334-342.

  46. Arnold JH, Truog RD, Rice SA. Prolonged administration of isoflurane to pediatrics patients during mechanical ventilation. Anesth Analg 1993;76:520-526.

  47. Smith RA, Winter PM, Smith M, et al. Tolerance to and dependence on inhalational anesthetic agents. Anesthesiology 1979;50:505-509.

  48. Spencer EM, Willatts SM, Prys-Roberts C. Plasma inorganic fluoride concentrations during and after prolonged (> 24 hrs) isoflurane sedation in the intensive care unit. Anesth Analg 1991;73:731-737.

  49. Arnold JH, Truog RD, Molengraft JA. Tolerance to isoflurane during prolonged administration. Anesthesiology 1993;78:985-988.

  50. Hughes J, Leach HJ, Choonara I. Hallucinations on withdrawal of isoflurane used as sedation. Acta Pediatr 1993;82:885-886.

  51. Tobias JD. Subcutaneous administration of fentanyl and midazolam to prevent withdrawal following prolonged sedation in children. Crit Care Med 1999;27:2262-2265.

  52. Miser AW, Davis DM, Hughes CS, et al: Continuous subcutaneous infusion of morphine in children with cancer. Am J Dis Child 1983;137:383-385.

  53. Tobias JD, O’Connor TA. Subcutaneous administration of fentanyl for sedation during mechanical ventilation in an infant. Am J Pain Manage 1996;6:115-117.

  54. Tobias JD. Outpatient therapy of iatrogenic opioid dependency following prolonged sedation in the pediatric intensive care unit. J Intensive Care Med 1996;11:284-287.

  55. Nathenson G, Golden GS, Litt IF. Diazepam in the management of the neonatal narcotic withdrawal syndrome. Pediatrics 1971;48:523-527.

  56. Kaltenbach K, Finnegan LP. Neonatal abstinence syndrome, pharmacotherapy, and developmental outcome. Neurobehav Toxicol Teratol 1986; 8:353-355.

  57. Kron RE, Litt M, Eng D, et al. Neonatal narcotic abstinence: Effects of pharmacotherapeutic agents and maternal drug usage on nutritive sucking behavior. J Pediatr 1976;88:637-664.

  58. Madden JD, Chappel JN, Zuspan F, et al: Observation and treatment of neonatal narcotic withdrawal. Am J Obstet Gynecol 1989;127:199-201.

  59. Kandall SR. Managing neonatal withdrawal. Drug Therapy 1976;6:47-59.

  60. Cobrinik RW, Hood RTJ. The effect of maternal narcotic addiction on the newborn infant. Pediatrics 1959;24:288-293.

  61. Gold MS, Redmond DER Jr, Kleber HD. Clonidine blocks acute opiate-withdrawal symptoms. Lancet 1978;ii:599-602.

  62. Hoder EL, Leckman JF, Ehrenkranz R, et al. Clonidine in neonatal narcotic-abstinence syndrome. N Engl J Med 1981;305:1284-1285.

  63. Roy-Byrne PP, Hommer D. Benzodiazepine withdrawal: Overview and implications for the treatment of anxiety. Am J Med 1988;84:1041-1052.

  64. Finkel JC, Elrefai A. The use of dexmedetomidine to facilitate opioid and benzodiazepine detoxification in an infant. Anesth Analg 2004;98:1658-1659.

  65. Maccioli GA. Dexmedetomidine to facilitate drug withdrawal. Anesthesiology 2003;98:575-577.

  66. Shafer A. Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med 1998;26:947-956.

  67. Tobias JD. Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med 2000;28:2122-2132.

  68. Celis RE, Besso CJ, Birchenall MA, de la Cal MA, Carrillo ER, Castorena AG, Ceraso D, Dueñas C, Gil F, et al. Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo. Med Intensiva 2007;31:428-471.




2020     |     www.medigraphic.com