Clinical Pharmacokinetics of Anxiolytics and Hypnotics in the Elderly

Greenblatt, David J.; Harmatz, Jerold S.; Shader, Richard I.

doi:10.2165/00003088-199121040-00003

Cited by 127 publications

(41 citation statements)

References 131 publications

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“…The probability of experiencing postoperative pain was reduced by 3% for each additional year of life. 13,14 Furthermore, the age-related reduction of plasma protein concentration might increase the percentage of unbound active drug concentration. 3,8,9 It was suggested that older patients may be more pain tolerant owing to a loss of pain perception.…”

Section: Discussionmentioning

confidence: 99%

Prospective Assessment of Postoperative Pain After Craniotomy

Mordhorst¹,

Latz²,

Kerz³

et al. 2010

Journal of Neurosurgical Anesthesiology

114

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logistic regression and chi using SPSS program (Windows, version 12.0). During the first 24 hours 87% of the patients experienced pain (NRS 1 to 3: 32%, NRS 4 to 7: 44%, NRS 8 to 10: 11%). For postoperative analgesia, the opioid piritramide (a mu-receptor agonist) was administered to 70% and nonopiod analgesics to 73% of the patients. The probability of experiencing postcraniotomy pain was reduced by 3% for each year of life. Maintenance of anesthesia with sevoflurane increased the probability of suffering from postcraniotomy pain by 147% and the absence of corticosteroids by 119%. Other investigated parameters did not influence pain after craniotomy. This study shows that pain is experienced by the majority of patients after craniotomy, despite conventional pain management, emphasizing the necessity for improved and individualized pain management in this special group of patients.

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Section: Discussionmentioning

confidence: 99%

Prospective Assessment of Postoperative Pain After Craniotomy

Mordhorst¹,

Latz²,

Kerz³

et al. 2010

Journal of Neurosurgical Anesthesiology

114

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“…Hepatic drug-metabolizing enzymes, including cytochrome (CYP) P450 enzymes (with CYP3A4 primarily responsible for metabolizing fentanyl in humans) (5), are reduced in quantity and function in older patients (6), who make up the majority of ICU patients. Moreover, critical illness often results in failure of organs that affect pharmacokinetics, e.g., the liver, kidney, and heart.…”

mentioning

confidence: 99%

Population Pharmacokinetics of Fentanyl in the Critically Ill*

Choi

Ferrell

Vasilevskis

et al. 2016

Critical Care Medicine

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Objective To characterize fentanyl population pharmacokinetics in patients with critical illness and identify patient characteristics associated with altered fentanyl concentrations. Design Prospective cohort study. Setting Medical and surgical ICUs in a large tertiary care hospital in the United States. Patients Patients with acute respiratory failure and/or shock who received fentanyl during the first five days of their ICU stay. Measurements and Main Results We collected clinical and hourly drug administration data and measured fentanyl concentrations in plasma collected once daily for up to five days after enrollment. Among 337 patients, the mean duration of infusion was 58 hours at a median rate of 100 µg/hr. Using a nonlinear mixed-effects model implemented by NONMEM, we found fentanyl pharmacokinetics were best described by a two-compartment model in which weight, severe liver disease, and congestive heart failure most affected fentanyl concentrations. For a patient population with a mean weight of 92 kg and no history of severe liver disease or congestive heart failure, the final model, which performed well in repeated 10-fold cross-validation, estimated total clearance (CL), intercompartmental clearance (Q), and volumes of distribution for the central (V1) and peripheral compartments (V2) to be 35 (95% confidence interval: 32 to 39) L/hr, 55 (42 to 68) L/hr, 203 (140 to 266) L, and 523 (428 to 618) L, respectively. Severity of illness was marginally associated with fentanyl pharmacokinetics but did not improve the model fit after liver and heart disease were included. Conclusions In this study, fentanyl pharmacokinetics during critical illness were strongly influenced by severe liver disease, congestive heart failure, and weight, factors that should be considered when dosing fentanyl in the ICU. Future studies are needed to determine if data-driven fentanyl dosing algorithms can improve outcomes for ICU patients.

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“…Rekonstruktive Therapie bei eingeschränkten physischen und psychischen Ressourcen gnitive Leistung und somit die zahnärztliche Behandlungs-und Betreuungsfähigkeit gerade älterer Patienten massiv zu reduzieren vermögen [14,15]. Dies trifft u. a. auf die sog.…”

Section: Der Alternde Patient Mit Seinen Besonderen Bedürfnissenunclassified

Der alternde Patient mit seinen besonderen Bedürfnissen - Rekonstruktive Therapie bei eingeschränkten physischen und psychischen Ressourcen

Besimo¹

2013

ZWR

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Die Herausforderungen bei der rekonstruktiven Rehabilitation alternder Menschen sind vielschichtig. So m?ssen einerseits die allgemeinmedizinischen und psychosozialen Rahmenbedingungen der Patienten m?glichst vollst?ndig erfasst werden, um therapeutische Fehlentscheidungen sowie ?ber- oder Unterversorgungen vermeiden zu k?nnen. Andererseits gilt es zu entscheiden, inwieweit rekonstruktive Ma?nahmen ?berhaupt indiziert sind, und wenn ja, die korrekte Wahl unter der Vielzahl rekonstruktiver Therapiem?glichkeiten zu treffen, die in den letzten Jahrzehnten durch Implantologie und adh?sive Technologien noch wesentlich erweitert wurden. Schlie?lich ist nach Abschluss der prothetischen Versorgung auch die Langzeitbetreuung alternder Menschen sicherzustellen, um in erster Linie biologische, aber auch technische Misserfolge m?glichst zu vermeiden. Diese Herausforderungen k?nnen nur bew?ltigt werden, wenn es uns gelingt, ?ltere Menschen in einem engen interdisziplin?ren Verbund von Medizin und Zahnmedizin zu behandeln und zu betreuen, unter Einbezug weiterer beteiligter Fachpersonen und Institutionen, wie dies in der vorliegenden Arbeit in Theorie und Praxis vorgestellt wird.

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Clinical Pharmacokinetics of Anxiolytics and Hypnotics in the Elderly

Cited by 127 publications

References 131 publications

Prospective Assessment of Postoperative Pain After Craniotomy

Prospective Assessment of Postoperative Pain After Craniotomy

Population Pharmacokinetics of Fentanyl in the Critically Ill*

Der alternde Patient mit seinen besonderen Bedürfnissen - Rekonstruktive Therapie bei eingeschränkten physischen und psychischen Ressourcen

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