Document Detail


Cardiovascular manifestations of sedatives and analgesics in the critical care unit.
MedLine Citation:
PMID:  19092649     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
There are numerous sedatives and analgesics used in critical care medicine today; these medications are used on critically ill patients, many of whom have heart disease, including coronary artery disease or congestive heart failure. The purpose of this review is to recognize the effects of these medications on the heart. Studies that evaluated the effects of sedatives and analgesics on normal individuals or on those with heart disease were reviewed. Current choices for sustained sedation in the critically ill include the benzodiazepines, morphine, propofol, and etomidate. Each of these medications has their particular advantages and disadvantages. Benzodiazepines provide the greatest amnesia and cardiovascular safety but they can cause significant hypotension in the hemodynamically unstable patient. Morphine provides analgesia and cardioprotective activity after ischemia, although the large observational study CRUSADE showed increased mortality rate in those patients with non-ST segment elevation myocardial infarction who received morphine. Propofol is the most easily titratable drug with cardioprotective features, but its use must be accompanied with great attention to possible development of propofol infusion syndrome, which is a deadly disease, especially in patients with head injury and those with septic shock receiving vasopressors. Etomidate has a rapid onset effect and short period of action with great hemodynamic stability even in patients with shock and hypovolemia, but the incidence of adrenal insufficiency during infusion, not bolus doses, may cause deterioration in the circulatory stability. In conclusion, the sedatives and analgesics mentioned here have characteristics that give them a cardiovascular safety profile useful in critically ill patients. However, use of these drugs on an individual basis is dependent on each agent's safety and efficacy.
Authors:
Jamil Darrouj; Lama Karma; Rohit Arora
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of therapeutics     Volume:  16     ISSN:  1536-3686     ISO Abbreviation:  Am J Ther     Publication Date:    2009 Jul-Aug
Date Detail:
Created Date:  2009-07-20     Completed Date:  2009-09-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9441347     Medline TA:  Am J Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  339-53     Citation Subset:  IM    
Affiliation:
Department of Medicine, Rosalind Franklin University of Medicine and Science/Chicago Medical School, North Chicago, Illinois, USA.
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MeSH Terms
Descriptor/Qualifier:
Analgesics, Opioid / administration & dosage,  adverse effects*
Animals
Benzodiazepines / administration & dosage,  adverse effects
Bradycardia / chemically induced
Coronary Artery Disease / physiopathology*
Critical Illness
Etomidate / administration & dosage,  adverse effects
Heart Failure / physiopathology*
Hemodynamics / drug effects
Humans
Hypnotics and Sedatives / administration & dosage,  adverse effects*
Hypotension / chemically induced
Intensive Care Units*
Morphine / administration & dosage,  adverse effects
Propofol / administration & dosage,  adverse effects
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Hypnotics and Sedatives; 12794-10-4/Benzodiazepines; 2078-54-8/Propofol; 33125-97-2/Etomidate; 57-27-2/Morphine

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


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