Propofol for benzodiazepine-refractory alcohol withdrawal in a non-mechanically ventilated patient.
Long-term alcohol use confers neurochemical changes in response to alcohol's exogenous inhibitory effects. Downregulation and decreased sensitivity of γ-aminobutyric acid receptors render benzodiazepines less effective at controlling psychomotor agitation. Propofol has been reported to have successfully relieved alcohol withdrawal syndrome (AWS) symptoms in part because of activation of γ-aminobutyric acid channels in combination with antagonism of excitatory amino acids such as N-methyl-D-aspartate. Successful use of propofol in refractory AWS in patients with endotracheal intubation and mechanical ventilation has been reported. We present a case of resolution of AWS symptoms in a benzodiazepine-refractory, nonintubated, non-mechanically ventilated alcohol withdrawal patient with low-dose, continuous-infusion propofol.
Department of Pharmacy Services, University Health System, San Antonio, TX, USA; Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, TX, USA; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: darrel.hughes@uhs-sa.com.
Darrel W
DW
Hughes
Department of Pharmacy Services, University Health System, San Antonio, TX, USA; Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, TX, USA; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Pharmacy Practice, University of the Incarnate Word Feik School of Pharmacy, San Antonio, TX, USA.
Elizabeth
E
Vanwert
Department of Emergency Medicine, School of Medicine, The University of Texas Health Science Center at San Antonio, TX, USA.
Lauren
L
Lepori
Department of Emergency Medicine, School of Medicine, The University of Texas Health Science Center at San Antonio, TX, USA.
Bruce D
BD
Adams
D000328:Adult; D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000188:drug therapy*; D003975:Diazepam / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D015742:Propofol / Q000627:therapeutic use*; D017211:Treatment Failure
D006993:Hypnotics and Sedatives; D006220:Haloperidol; D008140:Lorazepam; D003975:Diazepam; D015742:Propofol