The Experts below are selected from a list of 25578 Experts worldwide ranked by ideXlab platform
Russel Roberts - One of the best experts on this subject based on the ideXlab platform.
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pharmacology of commonly used analgesics and Sedatives in the icu benzodiazepines propofol and opioids
Anesthesiology Clinics, 2011Co-Authors: John W Devlin, Russel RobertsAbstract:The ideal Sedative or analgesic agent should have a rapid onset of activity, a rapid recovery after drug discontinuation, a predictable dose response, a lack of drug accumulation,and no toxicity. Unfortunately, none of the earlier analgesics, the benzodiazepines,or propofol share all of these characteristics. Patients who are critically ill experience numerous physiologic derangements and commonly require high doses and long durations of analgesic and Sedative therapy. There is a paucity of well designed clinical trials evaluating the safety and efficacy of earlier Sedative and analgesic agents in the ICU. In addition, the ever-changing dynamics of patients who are critically ill makes the use of sedation a continual challenge during the course of each patient’s admission. To optimize care, clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of Sedatives and analgesics.
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pharmacology of commonly used analgesics and Sedatives in the icu benzodiazepines propofol and opioids
Critical Care Clinics, 2009Co-Authors: John W Devlin, Russel RobertsAbstract:Opioids, benzodiazepines, and propofol remain the mainstay by which to optimize patient comfort and facilitate mechanical ventilation in patients who are critically ill. Unfortunately none of these agents share all of the characteristics of the ideal Sedative or analgesic agent: rapid onset, rapid recovery, a predictable dose response, a lack of drug accumulation, and no toxicity. To optimize care, critical care clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of these Sedatives and analgesics.
John W Devlin - One of the best experts on this subject based on the ideXlab platform.
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pharmacology of commonly used analgesics and Sedatives in the icu benzodiazepines propofol and opioids
Anesthesiology Clinics, 2011Co-Authors: John W Devlin, Russel RobertsAbstract:The ideal Sedative or analgesic agent should have a rapid onset of activity, a rapid recovery after drug discontinuation, a predictable dose response, a lack of drug accumulation,and no toxicity. Unfortunately, none of the earlier analgesics, the benzodiazepines,or propofol share all of these characteristics. Patients who are critically ill experience numerous physiologic derangements and commonly require high doses and long durations of analgesic and Sedative therapy. There is a paucity of well designed clinical trials evaluating the safety and efficacy of earlier Sedative and analgesic agents in the ICU. In addition, the ever-changing dynamics of patients who are critically ill makes the use of sedation a continual challenge during the course of each patient’s admission. To optimize care, clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of Sedatives and analgesics.
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adverse drug events associated with the use of analgesics Sedatives and antipsychotics in the intensive care unit
Critical Care Medicine, 2010Co-Authors: John W Devlin, Stephanie Mallowcorbett, Richard R RikerAbstract:As critically ill patients frequently receive analgesics, Sedatives, and antipsychotics to optimize patient comfort and facilitate mechanical ventilation, adverse events associated with the use of these agents can affect all organ systems and result in substantial morbidity and mortality. Although many of these adverse effects are common pharmacologic manifestations of the agent, and therefore frequently reversible, others are idiosyncratic and thus unexpected. The critically ill are more susceptible to adverse drug events than nonintensive care unit patients due to the high doses and long periods for which each of these agents are often administered, the frequent use of intravenous formulations that contain adjuvants that may lead to toxicity in some instances, and the high prevalence of end-organ dysfunction that affects the pharmacokinetic and pharmacodynamic response to therapy. This paper will review the most common and serious adverse drug events reported to occur with the use of Sedatives, analgesics, and antipsychotics in the intensive care unit; highlight the pharmacokinetic, pharmacodynamic, and pharmacogenetic factors that can influence analgesic, Sedative, and antipsychotic response and safety in the critically ill; and identify strategies that can be used to minimize toxicity with these agents.
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pharmacology of commonly used analgesics and Sedatives in the icu benzodiazepines propofol and opioids
Critical Care Clinics, 2009Co-Authors: John W Devlin, Russel RobertsAbstract:Opioids, benzodiazepines, and propofol remain the mainstay by which to optimize patient comfort and facilitate mechanical ventilation in patients who are critically ill. Unfortunately none of these agents share all of the characteristics of the ideal Sedative or analgesic agent: rapid onset, rapid recovery, a predictable dose response, a lack of drug accumulation, and no toxicity. To optimize care, critical care clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of these Sedatives and analgesics.
Steven R Horbal - One of the best experts on this subject based on the ideXlab platform.
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the effects of alcohol cannabis and cigarette use on the initiation reinitiation and persistence of non medical use of opioids Sedatives and tranquilizers in adults
Drug and Alcohol Dependence, 2016Co-Authors: Brooke J Arterberry, Steven R HorbalAbstract:Abstract Background Non-medical prescription drug use (NMPDU) has been a growing concern due to increased prevalence and severity of consequences. Epidemiological research has identified alcohol, cannabis, and cigarette use to be associated with NMPDU and initiation. However, studies have not examined stages of NMPDU in relation to other substances, which can highlight salient factors associated with high risk stages of NMPDU, such as reinitiation and persistence. Methods This study used an adult sample from the National Epidemiologic Survey of Alcohol and Related Conditions Wave 1 (2001–2002) and Wave 2 (2004–2005) data. We examined non-users, prior users, and current users of opioids and Sedatives/tranquilizers at risk of initiation, reinitiation, and persistence between Wave 1 and Wave 2 in relation to early-onset and frequency of cannabis, cigarette, and alcohol use, controlling for sociodemographics. Results Early-onset of cigarette and alcohol use increased the odds of opioid use initiation; early-onset of cannabis, cigarette, and alcohol use increased the odds of Sedative/tranquilizer use initiation and opioid reinitiation, persistence, while early-onset cannabis increased the odds of Sedative/tranquilizer reinitiation and persistence. Frequency of cannabis and cigarette use predicted all three stages of opioid use, initiation/reinitiation of Sedatives/tranquilizers, and frequency of cannabis use alone predicted Sedative/tranquilizer persistence. Conclusions This study provided evidence that differentiating among those who have experienced initiation, reinitiation, or persistence of NMPDU via early-onset and frequency of alcohol, cigarettes, and cannabis is vital, as there are specific aspects that influence risk. Therefore, tailoring interventions at different stages to reduce NMPDU is crucial.
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the effects of alcohol cannabis and cigarette use on the initiation reinitiation and persistence of non medical use of opioids Sedatives and tranquilizers in adults
Drug and Alcohol Dependence, 2016Co-Authors: Brooke J Arterberry, Steven R HorbalAbstract:Abstract Background Non-medical prescription drug use (NMPDU) has been a growing concern due to increased prevalence and severity of consequences. Epidemiological research has identified alcohol, cannabis, and cigarette use to be associated with NMPDU and initiation. However, studies have not examined stages of NMPDU in relation to other substances, which can highlight salient factors associated with high risk stages of NMPDU, such as reinitiation and persistence. Methods This study used an adult sample from the National Epidemiologic Survey of Alcohol and Related Conditions Wave 1 (2001–2002) and Wave 2 (2004–2005) data. We examined non-users, prior users, and current users of opioids and Sedatives/tranquilizers at risk of initiation, reinitiation, and persistence between Wave 1 and Wave 2 in relation to early-onset and frequency of cannabis, cigarette, and alcohol use, controlling for sociodemographics. Results Early-onset of cigarette and alcohol use increased the odds of opioid use initiation; early-onset of cannabis, cigarette, and alcohol use increased the odds of Sedative/tranquilizer use initiation and opioid reinitiation, persistence, while early-onset cannabis increased the odds of Sedative/tranquilizer reinitiation and persistence. Frequency of cannabis and cigarette use predicted all three stages of opioid use, initiation/reinitiation of Sedatives/tranquilizers, and frequency of cannabis use alone predicted Sedative/tranquilizer persistence. Conclusions This study provided evidence that differentiating among those who have experienced initiation, reinitiation, or persistence of NMPDU via early-onset and frequency of alcohol, cigarettes, and cannabis is vital, as there are specific aspects that influence risk. Therefore, tailoring interventions at different stages to reduce NMPDU is crucial.
Brooke J Arterberry - One of the best experts on this subject based on the ideXlab platform.
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the effects of alcohol cannabis and cigarette use on the initiation reinitiation and persistence of non medical use of opioids Sedatives and tranquilizers in adults
Drug and Alcohol Dependence, 2016Co-Authors: Brooke J Arterberry, Steven R HorbalAbstract:Abstract Background Non-medical prescription drug use (NMPDU) has been a growing concern due to increased prevalence and severity of consequences. Epidemiological research has identified alcohol, cannabis, and cigarette use to be associated with NMPDU and initiation. However, studies have not examined stages of NMPDU in relation to other substances, which can highlight salient factors associated with high risk stages of NMPDU, such as reinitiation and persistence. Methods This study used an adult sample from the National Epidemiologic Survey of Alcohol and Related Conditions Wave 1 (2001–2002) and Wave 2 (2004–2005) data. We examined non-users, prior users, and current users of opioids and Sedatives/tranquilizers at risk of initiation, reinitiation, and persistence between Wave 1 and Wave 2 in relation to early-onset and frequency of cannabis, cigarette, and alcohol use, controlling for sociodemographics. Results Early-onset of cigarette and alcohol use increased the odds of opioid use initiation; early-onset of cannabis, cigarette, and alcohol use increased the odds of Sedative/tranquilizer use initiation and opioid reinitiation, persistence, while early-onset cannabis increased the odds of Sedative/tranquilizer reinitiation and persistence. Frequency of cannabis and cigarette use predicted all three stages of opioid use, initiation/reinitiation of Sedatives/tranquilizers, and frequency of cannabis use alone predicted Sedative/tranquilizer persistence. Conclusions This study provided evidence that differentiating among those who have experienced initiation, reinitiation, or persistence of NMPDU via early-onset and frequency of alcohol, cigarettes, and cannabis is vital, as there are specific aspects that influence risk. Therefore, tailoring interventions at different stages to reduce NMPDU is crucial.
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the effects of alcohol cannabis and cigarette use on the initiation reinitiation and persistence of non medical use of opioids Sedatives and tranquilizers in adults
Drug and Alcohol Dependence, 2016Co-Authors: Brooke J Arterberry, Steven R HorbalAbstract:Abstract Background Non-medical prescription drug use (NMPDU) has been a growing concern due to increased prevalence and severity of consequences. Epidemiological research has identified alcohol, cannabis, and cigarette use to be associated with NMPDU and initiation. However, studies have not examined stages of NMPDU in relation to other substances, which can highlight salient factors associated with high risk stages of NMPDU, such as reinitiation and persistence. Methods This study used an adult sample from the National Epidemiologic Survey of Alcohol and Related Conditions Wave 1 (2001–2002) and Wave 2 (2004–2005) data. We examined non-users, prior users, and current users of opioids and Sedatives/tranquilizers at risk of initiation, reinitiation, and persistence between Wave 1 and Wave 2 in relation to early-onset and frequency of cannabis, cigarette, and alcohol use, controlling for sociodemographics. Results Early-onset of cigarette and alcohol use increased the odds of opioid use initiation; early-onset of cannabis, cigarette, and alcohol use increased the odds of Sedative/tranquilizer use initiation and opioid reinitiation, persistence, while early-onset cannabis increased the odds of Sedative/tranquilizer reinitiation and persistence. Frequency of cannabis and cigarette use predicted all three stages of opioid use, initiation/reinitiation of Sedatives/tranquilizers, and frequency of cannabis use alone predicted Sedative/tranquilizer persistence. Conclusions This study provided evidence that differentiating among those who have experienced initiation, reinitiation, or persistence of NMPDU via early-onset and frequency of alcohol, cigarettes, and cannabis is vital, as there are specific aspects that influence risk. Therefore, tailoring interventions at different stages to reduce NMPDU is crucial.
Jesse B Hall - One of the best experts on this subject based on the ideXlab platform.
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use of Sedatives and neuromuscular blockers in a cohort of patients receiving mechanical ventilation
Chest, 2005Co-Authors: Alejandro C Arroliga, Fernando Frutosvivar, Jesse B Hall, Andres Esteban, Carlos Apezteguia, Luis Soto, Antonio AnzuetoAbstract:Objective To describe the use of Sedatives and neuromuscular blocking agents (NMBs) and their impact in outcome in an international cohort of patients receiving mechanical ventilation Methods We analyzed the database of a prospective, multicenter cohort of 5,183 adult patients who received mechanical ventilation for > 12 h. We considered that a patient received a given agent when it was administered for at least 3 h in a 24-h period Results A total of 3,540 patients (68%; 95% confidence interval [CI], 67 to 69%) received a Sedative at any time while receiving mechanical ventilation. The median number of days of use was 3 (interquartile range [IQR], 2 to 6 days). The persistent use of Sedative was associated with more days of mechanical ventilation (median, 4 days [IQR, 2 to 8 days], vs 3 days [IQR, 2 to 4 days] in patients who did not receive Sedatives [p Conclusions The use of Sedatives is very common, and their use is associated with a longer duration of mechanical ventilation, weaning time, and stay in the ICU. NMBs are used in 13% of the patients and are associated with longer duration of mechanical ventilation, weaning time, stay in the ICU, and higher mortality
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the long term psychological effects of daily Sedative interruption on critically ill patients
American Journal of Respiratory and Critical Care Medicine, 2003Co-Authors: John P. Kress, Brian K Gehlbach, Maureen Lacy, Neil H Pliskin, Anne S Pohlman, Jesse B HallAbstract:Critically ill patients often receive Sedatives, which may delay liberation from mechanical ventilation and intensive care unit discharge. Daily interruption of Sedatives alleviates these problems, but the impact of this practice on long-term psychological outcomes is unknown. We compared psychological outcomes of intensive care unit patients undergoing daily Sedative interruption (intervention) with those without this protocol (control). Assessments using (1) the Revised Impact of Event Scale (evaluates signs of posttraumatic stress disorder [PTSD]), (2) the Medical Outcomes Study 36 item short-form health survey, (3) the State-Trait Anxiety Inventory, (4) the Beck Depression Inventory-2, (5) and the Psychosocial Adjustment to Illness score (overall quality of adjustment to current or residual effects of illness) were done by blinded observers. The intervention group had a better total Impact of Events score (11.2 vs. 27.3, p = 0.02), a trend toward a lower incidence of PTSD (0% vs. 32%, p = 0.06), and a...
