Multicenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal

Wong, Adrian; Benedict, Neal; Kane‐Gill, Sandra L.

doi:10.1016/j.jcrc.2014.10.008

Cited by 37 publications

(53 citation statements)

References 33 publications

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“…BZD-resistant AWS has been defined as ! 40 mg of diazepam (or BZD equivalent) administered over 1 h, and seems to be a reasonable prompt for considering an adjunct (7,39). One may consider an adjunct agent at a lower BZD dose if the patient is a chronic alcoholic, due to the ''kindling effect''.…”

Section: Discussionmentioning

confidence: 99%

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Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome

Wong

Smithburger

Kane‐Gill

2015

The American Journal of Drug and Alcohol Abuse

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The use of dexmedetomidine in the management of severe alcohol withdrawal should be considered as an adjunctive agent. Dexmedetomidine appears to be well tolerated, with an expected decrease in blood pressure and heart rate. Seizures have occurred in patients with alcohol withdrawal despite the use of dexmedetomidine, with and without benzodiazepines, due to lack of γ-aminobutyric acid agonist administration.

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Section: Discussionmentioning

confidence: 99%

“…A major limitation in currently published studies is the use of adjunctive agents, which is not typically limited to one drug, in fact, combinations of up to seven agents have been used (39). Many of the studies included additional medications, most commonly antipsychotics, for management of AWS.…”

Section: Discussionmentioning

confidence: 99%

Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome

Wong

Smithburger

Kane‐Gill

2015

The American Journal of Drug and Alcohol Abuse

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“…1). Nevertheless, they may be considered as adjunctive therapy to benzodiazepines in the late stage of AWS, when agitation, delirium, and hallucinations are not controlled with BZD alone 3, 80…”

Section: Therapymentioning

confidence: 99%

“…Due to its rapid onset of action and short half‐life, it produces a “cooperative sedation” without necessity for intubation. As ɑ‐2 agonists lack the GABAergic activity to prevent and treat DT or seizures, they can only be used as adjunctive therapy to reduce autonomic hyperactivity that cannot be controlled by BZD alone 3, 80, 86. Several studies demonstrated a BZD‐sparing effect with significant reduction in BZD requirement 87, 88, 89…”

Section: Therapymentioning

confidence: 99%

“…Propofol has general anesthetic effects that often require intubation and mechanical ventilation. Its use is therefore restricted to the intensive care unit making this agent an adjunct therapy for refractory cases of AWS 3, 6, 80, 90, 91. Its application and experience in AWS is limited to only a few cases and rebound of withdrawal symptoms soon after stopping propofol infusion has been reported 10…”

Section: Therapymentioning

confidence: 99%

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Alcohol withdrawal syndrome: mechanisms, manifestations, and management

et al. 2016

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The alcohol withdrawal syndrome is a well‐known condition occurring after intentional or unintentional abrupt cessation of heavy/constant drinking in patients suffering from alcohol use disorders (AUDs). AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. Nonetheless, diagnosis and treatment are often delayed until dramatic symptoms occur. The purpose of this review is to increase the awareness of the early clinical manifestations of AWS and the appropriate identification and management of this important condition in a neurological setting.

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Use of Propofol Plus Dexmedetomidine in Patients Experiencing Severe Alcohol Withdrawal in the Intensive Care Unit

Love

Zimmermann

2019

The Journal of Clinical Pharma

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Alcohol abuse and alcohol withdrawal syndrome are major problems in the United States. This retrospective chart review assessed efficacy and safety of propofol plus dexmedetomidine used in combination as adjunctive therapy to benzodiazepines compared with either agent used alone in the treatment of severe alcohol withdrawal. Patients admitted to the intensive care unit and experiencing severe alcohol withdrawal between September 1, 2015 and September 30, 2018 were assessed for eligibility. Primary end points were change in the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA‐Ar) score and incidence of bradycardia and hypotension. The combination of propofol and dexmedetomidine was associated with a change in CIWA‐Ar score of −10.4 (95%CI −13.5 to −7.3) points compared with −4.7 (95%CI −6.6 to −2.8) points with propofol and −4.4 (95%CI −7.4 to −1.4) with dexmedetomidine (P = .21). Bradycardia was experienced by 11.1% of patients receiving the combination, 15.4% of patients receiving propofol, and 28.6% of patients receiving dexmedetomidine (P = .40). Patients receiving dexmedetomidine experienced hypotension at a rate of 21.4% compared with 22.2% of patients receiving the combination and 38.5% of patients receiving propofol (P = .08). Patients in the combination group also had a shorter length of hospital and intensive care unit stay and shorter time to extubation when compared with the propofol and dexmedetomidine groups. Although no statistical significance was found, the combination was associated with better efficacy and safety outcomes than produced by either agent used alone.

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Multicenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal

Cited by 37 publications

References 33 publications

Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome

Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

Use of Propofol Plus Dexmedetomidine in Patients Experiencing Severe Alcohol Withdrawal in the Intensive Care Unit

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