title: Tolerance and withdrawal issues with sedation.
abstract: The stay in an ICU is a complex mixture of providing optimal care while keeping the patient safe. Means of reducing the anxiety associated with the ICU stay include frequent reorientation and maintenance of patient comfort with sedation supplemented by analgesia as needed. The most common agents used to provide sedation include benzodiazepines, propofol, and the newer dexmedetomidine. Others include barbiturate agents, neuroleptics, clonidine, etomidate, ketamine, and supplemental opioid analgesics for pain control. A common complication of sedation is tolerance, which can lead to withdrawal if the sedation is discontinued hastily. This article evaluates the occurrence of tolerance and withdrawal in the most commonly used sedatives in critically ill patients.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA. zapantis@nsu.nova.edu
authors.forename: Antonia
authors.initials: A
authors.lastname: Zapantis
authors.forename: Simon
authors.initials: S
authors.lastname: Leung
mesh_terms: D000700:Analgesics / Q000009:adverse effects; D001569:Benzodiazepines / Q000009:adverse effects; D001682:Biological Availability; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods / Q000451:nursing*; D003422:Critical Care / Q000379:methods*; D020927:Dexmedetomidine / Q000009:adverse effects; D004334:Drug Administration Schedule; D004361:Drug Tolerance; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008657:Metabolic Clearance Rate; D015742:Propofol / Q000009:adverse effects; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D020927:Dexmedetomidine; D015742:Propofol