Sedative and Analgesic Medications: Risk Factors for Delirium and Sleep Disturbances in the Critically Ill
Division of Critical Care, Department of Anesthesiology, Vanderbilt University School of Medicine, 324 MAB, 1313 21st Avenue South, Nashville, TN 37232, USA. Critical Care Clinics
(Impact Factor: 2.16).
05/2006; 22(2):313-27, vii. DOI: 10.1016/j.ccc.2006.02.010
Sedatives and analgesics are routinely used in critically ill patients, although they have the potential for side effects, such as delirium and sleep architecture disruption. Although it should be emphasized that these medications are extremely important in providing patient comfort, health care professionals must also strive to achieve the right balance of sedative and analgesic administration through greater focus on reducing unnecessary or overzealous use. Ongoing clinical trials should help us to understand whether altering the delivery strategy, via daily sedation interruption, or protocolized target-based sedation or changing sedation paradigms to target different central nervous system receptors can affect cognitive outcomes and sleep preservation in our critically ill patients.
Available from: Roxanne Sterniczuk
- "Delirium is characterized as a transient state of confusion and disorientation with fluctuating intensity, often accompanied by cognitive impairment. Delirium is a strong predictor of longer ICU length of stay, mechanical ventilation use, and even mortality.85 Sleep deprivation can result in delirium-like symptoms, such as inattention and fluctuations in mental capacity; however, it is still unclear whether sleep disruption in the ICU is a cause, consequence, or comorbidity of delirium. "
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ABSTRACT: Maintaining a stable and adequate sleeping pattern is associated with good health and disease prevention. As a restorative process, sleep is important for supporting immune function and aiding the body in healing and recovery. Aging is associated with characteristic changes to sleep quantity and quality, which make it more difficult to adjust sleep–wake rhythms to changing environmental conditions. Sleep disturbance and abnormal sleep–wake cycles are commonly reported in seriously ill older patients in the intensive care unit (ICU). A combination of intrinsic and extrinsic factors appears to contribute to these disruptions. Little is known regarding the effect that sleep disturbance has on health status in the oldest of old (80+), a group, who with diminishing physiological reserve and increasing prevalence of frailty, is at a greater risk of adverse health outcomes, such as cognitive decline and mortality. Here we review how sleep is altered in the ICU, with particular attention to older patients, especially those aged 80 years. Further work is required to understand what impact sleep disturbance has on frailty levels and poor outcomes in older critically ill patients.
Available from: scidoc.org
- "The dopaminergic, cholinergic , GABAergic, serotonergic, and glutamatergic modulatory systems have all been proposed as possible pathways, but the exact pathophysiology remains uncertain [1-3]. Most drugs known to induce or exacerbate delirium are thought to do so through one of these pathways . "
Available from: Teijo I Saari
- "Establishing causality has been difficult because these drugs are often given to treat pre-existing behaviors that may result from delirium. In an attempt to establish causality to these drugs, Pandharipande et al. (2006) evaluated 11 covariates to determine factors that may contribute to the development of delirium. Lorazepam was an independent risk factor for developing delirium and patients receiving more than 20 mg of lorazepam over 24 h nearly developed subsequently delirium. "
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ABSTRACT: GABA is the major inhibitory neurotransmitter in the central nervous system (CNS). The type A GABA receptor (GABA(A)R) system is the primary pharmacological target for many drugs used in clinical anesthesia. The α1, β2, and γ2 subunit-containing GABA(A)Rs located in the various parts of CNS are thought to be involved in versatile effects caused by inhaled anesthetics and classic benzodiazepines (BZD), both of which are widely used in clinical anesthesiology. During the past decade, the emergence of tonic inhibitory conductance in extrasynaptic GABA(A)Rs has coincided with evidence showing that these receptors are highly sensitive to the sedatives and hypnotics used in anesthesia. Anesthetic enhancement of tonic GABAergic inhibition seems to be preferentially increased in regions shown to be important in controlling memory, awareness, and sleep. This review focuses on the physiology of the GABA(A)Rs and the pharmacological properties of clinically used BZDs. Although classic BZDs are widely used in anesthesiological practice, there is a constant need for new drugs with more favorable pharmacokinetic and pharmacodynamic effects and fewer side effects. New hypnotics are currently developed, and promising results for one of these, the GABA(A)R agonist remimazolam, have recently been published.
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