Alcohol Withdrawal Syndrome Sedation javier benitez (@jvrbntz) In 5 slides or less...
Case PresentationA middle age man with multiple comorbiditiesincluding previous ICU admissions for AWSwith delirium tremens. He is in the hospitalthis time with AWS and agitation difficult tocontrol.Discuss the progression of sedative agents thatmay be used in agitated patients with severedelirium?
● 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
ReferenceAlcohol 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, MDCritical Care Clinics, Volume 28, Issue 4 , Pages 549-585, October 2012