Alcohol Withdrawal SyndromeSedation

javier benitez (@jvrbntz)

In 5 slides or less...

Case PresentationA middle age man with multiple comorbidities including previous ICU admissions for AWS with delirium tremens. He is in the hospital this time with AWS and agitation difficult to control.

Discuss the progression of sedative agents that may be used in agitated patients with severe delirium?

● Progressively IV bolus of benzodiazepines or barbiturates

– Associated with decrease length of stay, mechanical ventilation, pneumonia in not severely agitated

– Phenobarb: narrow therapeutic window, long half-life

● Titrated IV infusion of benzodiazepines– Consider in more severe agitated patients,especially if

sedation was not achieved with IV bolus

● Addition of IV rescue to #1 or #2 – Propofol: risks of hypotension, bradycardia, propofol

infusion syndrome

– Dexmedetomedine: a agonist > clonidine, less delirium

● These meds have the risk of respiratory depression

Reference

Alcohol Withdrawal SyndromeRichard W. Carlson, MD, PhD, Nivedita N. Kumar, MD, Edna Wong-Mckinstry, MD, Srikala Ayyagari, MD, Nitin Puri, MD, Frank K. Jackson, Shivaramaiah Shashikumar, MD

Critical Care Clinics, Volume 28, Issue 4 , Pages 549-585, October 2012