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Medications for pain relief are an important component of therapy for intensive care
patients. Opioids, the most commonly used analgesics in the ICLJ setting, are associated
with a large number of adverse effects that are related to their binding properties
at opioid-receptor subtypes. Other analgesics, such as ketamine and nonsteroidal anti-inflammatory
agents, may cause fewer cardiovascular and respiratory effects, but lead to other
unwanted effects in ICU patients. In addition to a review of analgesic-associated
adverse effects and drug interactions, guidelines for anticipating and monitoring
these agents are presented.
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References
- Prophylactic oral naltrexone with epidural morphine: Effect on adverse reactions and ventilatory responses to carbon dioxide.Anesthesiology. 1990; 72: 233-237
- The opioid system and temperature regulation.Ann Rev Pharmacol Ther. 1988; 28: 429-449
- Tolerance of locus coeruleus neurones to morphine and suppression of withdrawal response by clonidine.Nature. 1978; 276: 186-189
- Cerebral monoamine neurotransmitters in opioid withdrawal and dependence.Med Biol. 1987; 65: 113-119
- Analgesia and sedation in intensive care.Br J Anaesth. 1989; 63: 196-206
- Effects of U-50488H, a selective k-analgesic, on the minimum anesthetic concentration (MAC) of halothane in the rat.Anesth Analg. 1987; 66: 391-394
- Paralytic ileus during ketamine infusion.Anaesthesia. 1989; 44: 74
- Ventilatory effects during and after continuous infusion of fentanyl or alfentanil.Br J Anaesth. 1983; 55: 211S-216S
- Neonatal abstinence syndrome in infants sedated with fentanyl.Anesthesiology. 1989; 71: A218
- Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil.Anesth Analg. 1990; 70: 8-15
- Midazolam acts synergistically with fentanyl for induction of anaesthesia.Br J Anaesth. 1990; 64: 45-47
- Acute pain: A review of its effects and therapy with systemic opioids.in: Benedetti C Chapman C.R. Giron G Opioid Analgesia: Recent Advances in Systemic Administration. Raven Press, New York1990: 367-424
- Physiology of alfentanil-induced rigidity.Anesthesiology. 1986; 64: 440-446
- Concerning the possible nature of reported fentanyl seizures.Anesthesiology. 1985; 62: 205
- Efficacy of patient-controlled versus conventional analgesia for postoperative pain.Clin Pharm. 1985; 4: 48-52
- Myoclonus following sufentanil without EEG seizure activity.Anesthesiology. 1987; 67: 593-595
- Practical aspects of epidural and intrathecal narcotic analgesia in the intensive care setting.Heart Lung. 1989; 19: 599-608
- The effects of ventilation of ketorolac in comparison with morphine.Eur J Clin Pharmacol. 1988; 35: 491-494
- Tonic-clonic activity after sufentanil.Anesth Analg. 1987; 66: 481
- Nonrespiratory side effects of epidural morphine.Anesth Analg. 1982; 61: 490-495
- Continuous SC infusion of metoclopramide for treatment of narcotic bowel syndrome.Cancer Treat Rep. 1987; 71: 1121-1122
- Non-cardiogenic pulmonary edema after narcotic treatment for cancer pain.Pain. 1989; 39: 297-300
- Delayed respiratory depression following fentanyl anesthesia for cardiac surgery.Crit Care Med. 1988; 16: 238-240
- Acute respiratory arrest and rigidity after anesthesia with sufentanil: A case report.Anesthesiology. 1985; 63: 710-711
- Nalbuphine reversal of respiratory depression after epidural sufentanil.Crit Care Med. 1989; 17: 378-379
- Postoperative rigidity following fentanyl anesthesia.Anesthesiology. 1983; 58: 275-277
- Effect of analgesic drugs on the electromyographic activity of the gastrointestinal tract and sphincter of Oddi and on biliary pressure.Ann Surg. 1986; 204: 53-58
- Assessment of alfentanil by intravenous infusion as long-term sedation in intensive care.Anaesthesia. 1987; 42: 545-548
- Effects of ketorolac tromethamine on hemostasis in volunteers.Clin Pharmacol Ther. 1988; 43: 542-546
- Epidural opioid analgesia.Crit Care Clin. 1990; 6: 315-342
- A blinded study using nalbuphine for prevention of pruritus induced by epidural fentanyl.Anesthesiology. 1988; 69: 763-765
- Comparison of sufentanil-O2 and fentanyl-O2 for coronary artery surgery.Anesthesiology. 1982; 56: 112-118
- Down-regulation of δ but not µ opioid receptors in the hippocampal slice associated with loss of physiological response.Life Sci. 1983; 33 (suppl l): 333-336
- Sedation and analgesia during intensive care.Clin Anaesthesiol. 1985; 3: 1055-1085
- Twenty-five years of ketamine: A report of an international meeting.Anaesthesia. 1990; 45: 159-160
- Meperidine-induced delirium.Am J Psychiatry. 1987; 144: 1062-1065
- OompaiIson of ketoiclac, pentazocine, and placebo in treating postoperative pair.Cmr Ther Res. 1988; 43: 1173-1182
- The use of pethidine and morphine in the presence of monoamine oxidase inhibitors.Br J Anaesth. 1968; 40: 279-282
- Potentially lethal interaction of cimetidine and morphine.Can Med Assoc J. 1981; 124: 1434-1435
- Phenytoin and methadone tolerance.N Engl J Med. 1976; 294: 227
- Histamine release by four narcotics: A double-blind study in humans.Anesth Analg. 1987; 66: 723-730
- Dexmedetomidine, a selective a2-agonist, does not potentiate the cardiorespiratory depression of alfentanil in the rat.Anesthesiology. 1990; 72: 882-888
- Methotrexate and nonsteroidal anti-inflammatory drugs.Br Med J. 1987; 294: 776
- Clonidine blocks acute opiate withdrawal symptoms.Lancet. 1978; 2: 599-601
- Postoperative rigidity following sufentanil administration.Anesthesiology. 1985; 63: 199-201
- Cimetidine alters pethidine disposition in man.Br J Clin Pharmacol. 1984; 18: 907-914
- Ranitidine does not alter pethidine disposition in man.Br J Clin Pharmacol. 1985; 20: 55-59
- Effect of chronic administration of morphine on primary immune response in mice.Experientia. 1980; 36: 1309-1310
- Effect of levallorphan tartrate upon opiate-induced respiratory depression.Anesthesiology. 1953; 14: 550-554
- Propoxyphene in children with iatrogenic morphine depend ence: A review of the literature with two additional cases.Am J Dis Child. 1983; 137: 745748
- Midazolam as adjunct to high-dose fentanyl anaesthesia for coronary artery bypass grafting operation.Acta Anaesthesiol Scand. 1984; 28: 683-689
- Post-operative pain relief with ketamine infusion.Anaesthesia. 1974; 29: 222-229
- Opioid analgesics and antagonists.in: Gilman A.G. Goodman L.S. Rail T.W. The Pharmacological Basis of Therapeutics. ed 7. Macmillan, New York1985: 491-531
- Recurrent respiratory depression after alfentanil administration.Anesthesiology. 1989; 70: 151-153
- Reversal of opioid-induced muscular rigidity in rats: Evidence for a-2-adrenergic involvement.Pharmacol Biochem Behav. 1987; 28: 283289
- Low-dose ketamine infusion for analgesia during postoperative ventilator treatment.Acta Anaesthesiol Scand. 1986; 30: 697-702
- The interaction of ketamine with d-tubocurarine, pancuronium, and succinylcholine in man.Anesth Analg. 1974; 53: 496-501
- Ketamine addiction.Anesthesiology. 1987; 67: 861-862
- Airway opioid receptors mediate inhibition of cough and reflex bronchoconstriction in guinea pigs.J Pharmacol Exp Ther. 1990; 252: 863868
- Two instances of seizure-like activity in the same patient associated with two different narcotics.Anesth Analg. 1987; 67: 289-290
- Treatment of epidural morphine-induced pruritus with buprenorphine.Anaesthesia. 1989; 44: 691
- Effects of indomethacin on digoxin pharmacokinetics in preterm infants.Pediatr Pharmacol. 1984; 4: 25-30
- Alfentanil and delayed respiratory depression: Case studies and review.Anesth Analg. 1990; 70: 557-561
- Rifampin-induced methadone withdrawal.N Engl J Med. 1976; 294: 1104-1105
- Epidural morphine for postoperative analgesia: A double-blind study.Anesth Analg. 1982; 61: 236-240
- A double-blind placebo controlled endoscopic study comparing the mucosal injury seen with an orally and parenterally administered new nonsteroidal analgesic, ketorolac tromethamine, at therapeutic and supratherapeutic doses.Am J Gastroenterol. 1987; 82: 939
- k Agonist-induced diuresis: Evidence for stereoselectivity, strain differences, independence of hydration variables and a result of decreased plasma vasopressin levels.J Pharmacol Exp Ther. 1987; 242: 33-39
- Wheal and flare responses to opioids in humans.Anesthesiology. 1989; 70: 756-760
- Meniere-like syndrome following epidural morphine analgesia.Anesthesiology. 1989; 71: 782-783
- Prophylactic transdermal scopolamine patches reduce nausea in postoperative patients receiving epidural morphine.Anesth Analg. 1989; 68: 144-146
- Involvement of locus coeruleus and noradrenergic neurotransmission in fentanyl-induced muscular rigidity in the rat.Neurosci Lett. 1989; 96: 114-119
- Morphine-induced pulmonary edema.Am J Med. 1988; 84: 367-368
- Psychomotor effects of ketorolac in comparison with buprenorphine and diclofenac.Br J Clin Pharmacol. 1989; 27: 453-459
- Delayed respiratory depression after alfentanil.Anesthesiology. 1988; 69: 593-595
- Relief of pain by infusion of morphine after operation: Does tolerance develop?.Br Med J. 1985; 291: 19-21
- Pharmacology of opioids.Pharmacol Rev. 1983; 35: 283-323
- Managing your patients’ adverse reactions to narcotics.Nursing. 1989; 19: 166-168
- Benzodiazepine-opiate antagonism—a problem in intensive-care therapy.Intensive Care Med. 1986; 12: 39-42
- Delayed and prolonged rigidity greater than 24 h following high-dose fentanyl anesthesia.Anesthesiology. 1988; 69: 624-625
- Narcotic withdrawal syndrome in young adults after the therapeutic use of opiates.Am J Dis Child. 1986; 140: 603-604
- Cimetidine does not alter morphine disposition in man.Br J Clin Pharmacol. 1982; 14: 809-813
- Comparison of the cardiorespiratory effects of ketorolac and alfentanil during propofol anaesthesia.Br J Anaesth. 1989; 63: 601-603
- Chest wall rigidity during fentanyl-and midazolam-fentanyl induction: Ventilatory and haemodynamic effects.Acta Anaesthesiol Scand. 1989; 33: 1-5
- Dissociation of µ opioid tolerance from receptor down-regulation in rat spinal cord.J Pharmacol Exp Ther. 1990; 253: 67-72
- Analgesia from morphine and ketamine: A comparison of infusions of morphine and ketamine for postoperative analgesia.Anaesthesia. 1987; 42: 1051-1056
- Infusions of analgesics, sedatives and muscle relaxants in patients who require intensive care.Anaesthesia. 1989; 44: 879-880
- Ketamine infusion: Its use as a sedative, inotrope and bronchodilator in a critically ill patient.Anaesthesia. 1987; 42: 980-983
- Myoclonic seizure activity with chronic high-dose spinal opioid administration.Anesthesiology. 1990; 72: 743-745
- Multiple morphine and enkephalin receptors and the relief of pain.JAMA. 1988; 259: 1362-1367
- Effect of pethidine, fentanyl and morphine on post-operative shivering in man.Acta Anaesthesiol Scand. 1984; 28: 138-143
- Comparison of intramuscular ketorolac and —morphine in pain control after laparotomy.Anaesthesia. 1990; 45: 538-542
- Convulsions: An unusual response to intravenous fentanyl administration.Anesth Analg. 1982; 61: 1020-1021
- Present state of extradural and intrathecal opioid analgesia in Sweden.Br J Anaesth. 1987; 59: 791-799
- Effects of diclofenac on lithium kinetics.Clin Pharmacol Ther. 1981; 30: 348-352
- Bradycardia after alfentanil-succinylcholine.Anesth Analg. 1988; 67: 907
- Hemodynamics and histamine release during induction with sufentanil or fentanyl.Anesthesiology. 1984; 60: 489-491
- Comparison of the effect of cisapride and metoclopromide on morphine-induced delay in gastric emptying.Br J Clin Pharmacol. 1988; 26: 741-746
- Cardiovascular responses to large doses of alfentanil and fentanyl.Br J Anaesth. 1983; 55: 223S-230S
- Ventilatory and mental effects of alfentanil and fentanyl.Acta Anaesthesiol Scand. 1984; 28: 63-67
- Seizure-like movements during a fentanyl infusion with absence of seizure activity in a simultaneous EEG recording.Anesthesiology. 1985; 62: 812-814
- Spinal opiate analgesia and facial pruritus: A neural theory.Postgrad Med J. 1982; 58: 531-535
- Fentanyl and convulsions.Anesth Analg. 1983; 62: 855-862
- Use of a fentanyl infusion in the intensive care unit: Tolerance to its anesthetic effects?.Anesthesiology. 1983; 59: 245-248
- Bradycardia following sufentanil-succinylcholine.Anesthesiology. 1987; 66: 106
- Long-term ketamine infusion.Anaesthesia. 1986; 41: 1262-1263
- The effect of diazepam on induction of anesthesia with alfentanil.Anesth Analg. 1986; 65: 71-77
- Amantidine in prevention of fentanyl-induced muscle rigidity.Anesth Analg. 1987; 66: 1338
- Alfentanil infusions on the intensive therapy unit.Intensive Care Med. 1988; 14: 55-59
- Seizures during opioid anesthetic induction—are they opioid-induced rigidity?.Anesthesiology. 1989; 71: 852-862
- High-dose sufentanil: Four cases of sudden hypotension on induction.Anesth Analg. 1986; 65: 703-705
- Postoperative urinary retention in general surgical patients.Br J Surg. 1988; 75: 1141-1143
- Drug interaction: Meperidine and chlorpromazine, a toxic combination.J Clin Pharmacol. 1981; 21: 140-146
- The effect of phenobarbital on the metabolism of meperidine in normal volunteers.J Clin Pharmacol. 1978; 18: 482-490
- Effect of modern analgesic drugs (tramadol, pentazocine, and buprenorphine) on the bile duct sphincter in man.Gut. 1986; 27: 567-569
- Bradycardia and asystole following the rapid administration of sufentanil and vecuronium.Anesthesiology. 1986; 64: 521-523
- Epidural morphine for postoperative pain: Experience with 1085 patients.Acta Anaesthesiol Scand. 1985; 29: 148-156
- Nonsteroidal anti-inflammatory drug nephrotoxicity: Should we be concerned?.Arch Intern Med. 1990; 150: 268-270
- Pharmacokinetics of fentanyl as a possible explanation for recurrence of respiratory depression.Br J Anaesth. 1979; 51: 741-745
- Probable seizure after alfentanil.Anesth Analg. 1989; 68: 692-693
- Continuous naloxone infusion for opiate poisoning in infancy.J Pediatr. 1984; 105: 645-648
- Interaction of ketamine with atracurium.Br J Anaesth. 1989; 62: 319-320
- Phenytoin-induced methadone withdrawal.Ann Intern Med. 1981; 94: 349-351
- Effect of morphine on resistance to infection.J Infect Dis. 1983; 148: 656-666
- Midazolam-morphine sedative interaction in patients.Anesth Analg. 1989; 68: 282-285
- Comparison of epidural sufentanil plus clonidine with sufentanil alone for postoperative pain relief.Anaesthesia. 1990; 45: 531-534
- Midazolam-alfentanil synergism for anesthetic induction in patients.Anesth Analg. 1989; 69: 213-217
- Interactions of NSAIDs with diuretics and (3-blockers: Mechanisms and clinical implications.Drugs. 1985; 30: 32-41
- Ketanserin pretreatment reverses alfentanil-induced muscle rigidity.Anesthesiology. 1987; 67: 348-354
- Localization of brainstem sites which mediate alfentanil-induced muscle rigidity in the rat.Pharmacol Biochem Behav. 1988; 29: 573-580
- Dexmedetomidine, acting through central α2-adrenoceptors, prevents opiate-induced muscle rigidity in the rat.Anesthesiology. 1989; 71: 242249
- Sudden hypotension associated with midazolam and sufentanil.Anesth Analg. 1987; 66: 693-694
- Mishaps with patient-controlled analgesia.Anesthesiology. 1987; 66: 81-83
- Comparison of alfentanil with fentanyl for outpatient anesthesia.Anesthesiology. 1986; 64: 99-106
- Postoperative respiratory depression and elevated sufentanil levels in a patient with chronic renal failure.Anesthesiology. 1985; 63: 708-710
- Postoperative pain relief; a new approach: Narcotics compared with nonsteroidal anti-inflammatory drugs [letter].Ann R Coll Surg Engl. 1990; 72: 66
- Comparison of intramuscular ketorolac tromethamine and morphine sulfate for analgesia of pain after major surgery.Pharmacotherapy. 1986; 6: 253-261
- Possible indomethacin-aminoglycoside interaction in preterm infants.J Pediatr. 1985; 106: 511-513
- Anaphylactic reaction to epidural fentanyl.Anesthesiology. 1989; 71: 599-601
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© 1991 Elsevier Inc. Published by Elsevier Inc. All rights reserved.