Document Detail


Analgesia in the intensive care unit. Pharmacologic and pharmacokinetic considerations.
MedLine Citation:
PMID:  11866403     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Morphine is the preferred analgesic agent for the critically ill patient. Fentanyl is the preferred analgesic agent for critically ill patients with hemodynamic instability or for patients manifesting symptoms of histamine release with morphine or morphine allergy. Hydromorphone is an acceptable alternative to morphine for patients with significant adverse affects from morphine or severe renal dysfunction. Meperidine and intravenous codeine should be avoided if at all possible. APAP and NSAIDs may be useful in the management of acute pain secondary to their opioid-sparing effects. Use of nonopioid analgesics may reduce the dose of opioid required for adequate pain control and help to minimize opioid-induced side effects. NSAIDs should be used only when the benefit-to-risk ratio is favorable. APAP should be used as an adjunct but not as the sole analgesic agent in critically ill patients. Regardless of which agent or agents are used to optimize pain control, it is imperative that caregivers recognize that the optimal analgesic dose and regimen vary widely between patients. Based on the pharmacokinetics and pharmacodynamics of the agent(s) selected, enough time for an adequate trial should be allowed before switching to other agents. Employing these principles optimizes the use of medications in the management of the complex physiologic response to pain.
Authors:
E J Nickel; T Smith
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Critical care nursing clinics of North America     Volume:  13     ISSN:  0899-5885     ISO Abbreviation:  Crit Care Nurs Clin North Am     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2002-02-27     Completed Date:  2002-04-17     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8912620     Medline TA:  Crit Care Nurs Clin North Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  207-19     Citation Subset:  N    
Affiliation:
Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Analgesics, Non-Narcotic / administration & dosage*,  adverse effects,  pharmacokinetics,  pharmacology*
Analgesics, Opioid / administration & dosage*,  adverse effects,  pharmacokinetics,  pharmacology*
Biological Availability
Drug Administration Routes
Humans
Chemical
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 0/Analgesics, Opioid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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