Critical care clinics
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Critical care clinics · Jul 1991
ReviewNeuromuscular blocking agents and sedative drugs. Clinical uses and toxic effects in the critical care unit.
The use of sedatives and muscle relaxants is common in the ICU. Therapeutic goals should be carefully established. Monitoring of desired effects and toxic side effects is essential to avoid preventable morbidity.
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Critical care clinics · Jul 1991
ReviewToxic effects of drugs used in the ICU. Nitroprusside, nitroglycerin, and angiotensin-converting enzyme inhibitors.
Sodium nitroprusside causes cyanide poisoning at currently recommended infusion rates. Serum thiocyanate concentrations are of no value in detecting cyanide poisoning caused by nitroprusside. Methemoglobinemia in those patients receiving intravenous nitroglycerin may seriously impair oxygen delivery and is not always accompanied by cyanosis in anemic patients. Angiotensin-converting enzyme inhibitors are responsible for a plethora of adverse effects, including renal insufficiency, hypotension, angioedema, cough, and increased insulin sensitivity.
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Colloid fluid solutions are frequently used as plasma volume expanders in the critically ill. As a group, these nonblood volume replacement solutions have in common a number of potential adverse effects. ⋯ Renal dysfunction has been associated with dextran 40, myocardial depression with albumin, hypotension with purified plasma protein, and hyperamylasemia with hetastarch. Because no ideal colloidal solution exists, knowledge of type, severity, and clinical significance of adverse effects is important in determining the appropriate plasma volume expander and monitoring its effects.
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Critical care clinics · Jul 1991
ReviewOpioids and other analgesics. Adverse effects in the intensive care unit.
Analgesics are an important component of care for critically ill patients. The agents available--opioids, anesthetics, and NSAIDs--are efficacious, but each is capable of inducing a variety of adverse effects. ⋯ Anesthetic agents and NSAIDs offer less effect on cardiovascular and respiratory function than opioids, but are not without adverse effects. A thorough understanding of analgesic-associated adverse effects and drug interactions, as well as methods for anticipating and monitoring them, can help to minimize their effect on the ICU patient.