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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 26 (2000), S. 922-928 
    ISSN: 1432-1238
    Keywords: Key words Sedation ; Intensive care ; Propofol ; Benzodiazepines ; Opiates ; Neuro-muscular block
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Sedation is central to the management of intensive care patients. Many different techniques have been tried, all have potential side effects, and some have been associated with serious adverse effects. The aim of this work is to establish current sedation practice in British ICUs; the use of neuromuscular blocking drugs and the indications for their use, the use of sedation policies and scoring systems, the influence of cost on drug choice, and the use of propofol for sedation in paediatric patients. Design: A postal survey sent to all units identified in the Directory of Emergency Services. Results: Two hundred and fifty-five replies were received from 323 questionnaires (79 % response rate). The replies show that alfentanil, morphine, midazolam, and propofol are the most widely used drugs for sedation, and that changes occur in sedation policy with the time a patient spends in intensive care. Atracurium is the most widely used neuromuscular blocking drug, but the number of patients who receive therapeutic paralysis is relatively small and the indications for its use in different units is consistent. Propofol is used by many ICUs for the sedation of children despite reports linking its use to mortality in children and the advice of the regulatory authorities. Conclusions: Drugs used for the sedation of patients in intensive care have changed since previous surveys. The sedation policy of most units relies on the combination of small numbers of drugs. Sedation policies now seem to concentrate on achieving a lightly sedated co-operative patient.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2072
    Keywords: Ethyl-alcohol ; Benzodiazepines ; Drug interactions ; Methods ; Psychomotor performance ; Self assessment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pharmacodynamic interactions of low doses of diazepam and alcohol were investigated in a double blind, randomised, 2×2 factorial, cross-over study in eight healthy volunteers. Alcohol or glucose 5% were administered intravenously at rates calculated to maintain breath alcohol levels of 0.5 g/l from 1.5 to 5.5 h after starting the alcohol infusion. Diazepam 5 mg or placebo were administered orally at 1.5 h. Evaluation of pharmacodynamic interactions was performed for the average results of tests performed at 2, 3.5 and 5 h. Plasma concentrations of (desmethyl-) diazepam and breath alcohol levels were measured for pharmacokinetic analysis. Breath alcohol reached pseudo steady state levels of 0.38 g/l (range: 0.24–0.57) after alcohol alone and 0.37 g/l (range: 0.27–0.52) in combination with diazepam. Alcohol effects were demonstrated for latency of saccadic eye movements, smooth pursuit eye movements and subjective drug effects. Diazepam impaired smooth pursuit and saccadic eye movements, adaptive tracking, digit symbol substitution and body sway. The effects of combined alcohol and diazepam were mostly additive without significant synergistic interactions. However, in two subjects large supra-additive effects occurred at 3.5 h following alcohol + diazepam, which were not explained by increased drug levels. The design and methods used in this study proved advantageous in evaluating low dose pharmacodynamic interactions. Despite the absence of significant synergistic interactions, unanticipated impairment of performance may occur in susceptible individuals when taking combined low doses of alcohol and diazepam.
    Type of Medium: Electronic Resource
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