Metabolic and endocrine effects of sedative agents.
OBJECTIVE
To bring to the attention of the clinician the metabolic effects of most common sedatives and analgesics used in critically ill patients.


RESULTS
Most patients admitted to the intensive care unit require sedation and analgesia to reduce anxiety, agitation, and delirium and provide pain relief. Inappropriate sedation and analgesia techniques can cause harm to the already compromised patient if they do not take into account the metabolic effect they produce.


CONCLUSIONS
Metabolically critical illness can be divided in two phases, and acute and a prolonged one. Whereas the acute or hypermetabolic phase is characterized by elevated circulating concentration of catabolic hormones and substrate utilization to provide energy to vital organs, the prolonged or catabolic phase of critical illness is marked by reduced endocrine stimulation and severe loss of body cell mass. The most common analgesic and sedative agents used in the intensive care unit, if used in small or moderate doses, do not interfere significantly with the metabolic milieu; however, prolonged infusions, and in high doses, without adequate monitoring of level of sedation and quality of analgesia, can precipitate morbid events. Further research is needed in the metabolic aspects of analgesia and sedation in the intensive care unit, particularly if a multimodal pharmacologic strategy is used whereby multiple interventions aim at minimizing the risk of overdosing and contributing to attenuation of the stress response associated with critical illness.
Mistraletti
Giovanni
G
Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
Donatelli
Francesco
F
Carli
Franco
F
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D002395:Catecholamines / Q000378:metabolism; D003131:Combined Modality Therapy / Q000379:methods; D003422:Critical Care / Q000379:methods*; D004703:Endocrine System / Q000187:drug effects*; D005045:Etomidate / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007328:Insulin / Q000378:metabolism; D007649:Ketamine / Q000627:therapeutic use; D008550:Melatonin / Q000378:metabolism; D008660:Metabolism / Q000187:drug effects*; D010146:Pain / Q000188:drug therapy / Q000378:metabolism; D015742:Propofol / Q000627:therapeutic use; D013963:Thyroid Hormones / Q000378:metabolism
D000316:Adrenergic alpha-Agonists; D000700:Analgesics; D000701:Analgesics, Opioid; D002395:Catecholamines; D006993:Hypnotics and Sedatives; D007328:Insulin; D013963:Thyroid Hormones; D019382:Human Growth Hormone; D001569:Benzodiazepines; D007649:Ketamine; D008550:Melatonin; D006854:Hydrocortisone; D015742:Propofol; D005045:Etomidate