Iatrogenic drug dependence--a problem in intensive care? Case study and literature review.
Use of sedative and analgesic pharmacological agents is a widespread practice in intensive care units (ICUs). Mainly, this involves opioid and benzodiazepine analogues, both known to induce dependence/tolerance states. This paper is based on a clinical scenario in which a patient treated with these agents developed problems when they had been discontinued, and exploration of the extent of such problems generally. The problems range across a wide range of domains and may include physical discomfort, difficulty weaning from respiratory assistance and the drugs, and the problems of short- and long-term psychological distress. Although there may be a recognition that these drugs can typically cause dependence problems, little emphasis has traditionally been given to assessing these problems in ICUs. Yet the ICU may be an area where these drugs are used in high volumes. The recognition, physiology, management and prevention of iatrogenic drug dependence/tolerance in critical care environments is elucidated, with reference to relevant literature.
Taylor
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Aintree Hospital, Liverpool, UK.
D000701:Analgesics, Opioid / Q000009:adverse effects*; D014151:Anti-Anxiety Agents / Q000009:adverse effects*; D001569:Benzodiazepines; D016292:Procedural Sedation / Q000009:adverse effects; D003422:Critical Care; D016903:Drug Monitoring; D004361:Drug Tolerance; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D008297:Male; D009730:Nursing Assessment; D019966:Substance-Related Disorders / Q000209:etiology* / Q000517:prevention & control*
D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D001569:Benzodiazepines