Intensive care units withdrawal

Tobias JD Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med 28 2122-2132, 2000... 

This drug has sedative and anticonvulsant properties. Its use in anaesthesia is now almost exclusively reserved for the management of acute withdrawal syndromes in the intensive care unit. It is thought that clomethiazole enhances GABAergic transmission in the brain. At normal dosages it has little effect on the cardiovascular system. 

Patients undergoing abrupt withdrawal from GBL are monitored in the intensive care unit and are typically hospitalized for about five days for supportive care and treatment with pentobarbital, a strong sedative sometimes used for anesthesia. Withdrawal symptoms are so severe that benzodiazepines, which are milder tranquilizers than pentobarbital and which are typically the first line of treatment... 

The withdrawal of an infusion of midazolam, used as sedation in intensive care units, is associated with occasional severe and bizarre behavioral disturbances, particularly in children (50). These are similar in nature to the withdrawal effects seen with other short-acting benzodiazepines. 

It should be stressed that baclofen withdrawal is a potentially fatal emergency. Because of the risk of rhab-domyolysis, disseminated intravascular coagulation, acute renal insufficiency, and other organ complications, patients should be transferred to the intensive care unit and given parenteral baclofen. 

Procedure Beta-lactam desensitization should be done in an intensive care unit and any concomitant risk factors for anaphylaxis, such as use of beta-blockers should be corrected. Protocols based on incremental use of the drug orally or parenterally have been described (190,193). The oral route is preferable and is associated with a lower incidence of adverse events, but mild transient reactions are frequent (171,194,195). Pregnant women with limited antibiotic choices have been treated with immunotherapy (196). Repeated administration will maintain a state of anergy, which is often lost after withdrawal (197). At the conclusion of therapy, patients must be informed that after withdrawal, they may once again become allergic to penicillin, with a new reaction to the first subsequent application (197). 

Pregnancy Tramadol withdrawal has been described in a 34-week gestational age boy admitted to the neonatal intensive care unit for evaluation of sepsis [196" ]. The mother had taken tramadol 600-800 mg/day during the pregnancy. Tramadol withdrawal was treated with oral clonidine. 

Drug withdrawal A withdrawal syndrome has been described after the use of remifenta-nil by infusion in intensive care units [166 ]. Within 10 minutes of withdrawal, patients experienced tachycardia, hypertension, sweating, mydriasis, and myoclonus. These symptoms persisted despite the use of morphine and clonidine and only resolved on readministration of remifentanil. Gradual tapering of remifentanil reduces the incidence of withdrawal symptoms. 

Kiikoyi A, Coker S, Lewis L, Nierenberg D. Two cases of acute dexmedetomidine withdrawal syndrome following prolonged infusion in the intensive care unit report of cases and review of the Hterahrre. Hum Exp Toxicol January 2013 32(1) 107-10. 

Cook D, Rocker G, Marshall J, et al. Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. N Engl J Med 2003 349 1123-1132. 

---