Propranolol-Associated Confused States during Alcohol Withdrawal

Jacob, Moire S.; Zilm, Duane H.; MacLeod, Stuart; Sellers, Edward M.

doi:10.1097/00004714-198306000-00009

Cited by 20 publications

(3 citation statements)

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“…Our decision to use barbiturates as our primary adjunct was based on numerous factors. First, although antiadrenergic agents (β-blockers and clonidine) have been used in combination with benzodiazepines for treatment of AWS in surgical patients, randomized placebo-controlled trials document that the greatest benefit to these agents is modulation of autonomic signs of AWS (heart rate and blood pressure), with only modest effects for these agents on treatment of delirium with some reports documenting an increase in delirium with β-blocker treatment (3,(26)(27)(28)(29). In similar fashion, a randomized controlled study of the α 2 -adrenergic agonist, lofexidine, documented an increase in delirium in subjects being treated for AWS with similar trends observed in postsurgical ICU subjects randomized to the combination of flunitrazepam/clonidine for treatment of AWS (3,30,31).…”

Section: Discussionmentioning

confidence: 99%

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

Gold

Rimal

Nolan

et al. 2007

Critical Care Medicine

158

164

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Objective-Patients with severe alcohol withdrawal and delirium tremens are frequently resistant to standard doses of benzodiazepines. Case reports suggest that these patients have a high incidence of requiring intensive care and many require mechanical ventilation. However, few data exist on treatment strategies and outcomes for these subjects in the medical intensive care unit (ICU). Our goal was a) to describe the outcomes of patients admitted to the medical ICU solely for treatment of severe alcohol withdrawal and b) to determine whether a strategy of escalating doses of benzodiazepines in combination with phenobarbital would improve outcomes. Design-Retrospective cohort study.Setting-Inner-city municipal hospital.Patients-Subjects admitted to the medical ICU solely for the treatment of severe alcohol withdrawal. Interventions-Institution of guidelines emphasizing escalating doses of diazepam in combination with phenobarbital.Measurements and Main Results-Preguideline (n = 54) all subjects were treated with intermittent boluses of diazepam with an average total and maximal individual dose of 248 mg and 32 mg, respectively; 17% were treated with phenobarbital. Forty-seven percent required intubation due to inability to achieve adequate sedation and need for constant infusion of sedative-hypnotics. Intubated subjects had longer length of stay (5.6 vs. 3.4 days; p = .09) and higher incidence of nosocomial pneumonia (42 vs. 21% p = .08). Postguideline (n = 41) there were increases in maximum individual dose of diazepam (32 vs. 86 mg; p = .001), total amount of diazepam (248 vs. 562 mg; p = .001), and phenobarbital use (17 vs. 58%; p = .01). This was associated with a reduction in the need for mechanical ventilation (47 vs. 22%; p = .008), with trends toward reductions in ICU length of stay and nosocomial pneumonia.Conclusions-Patients admitted to a medical ICU solely for treatment of severe alcohol withdrawal have a high incidence of requiring mechanical ventilation. Guidelines emphasizing escalating bolus doses of diazepam, and barbiturates if necessary, significantly reduced the need for mechanical ventilation and showed trends toward reductions in ICU length of stay and nosocomial infections.

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Section: Discussionmentioning

confidence: 99%

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

Gold

Rimal

Nolan

et al. 2007

Critical Care Medicine

158

164

View full text Add to dashboard Cite

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“…Moreover, self administration studies show greater reinforcement of self administration or addiction potential of diazepam over chlordiazepoxide. 25,30 The best predictor of future withdrawal is prior withdrawal. In those cases where a known history of DT's is present, benzodiazepines can be given as often as q one hour and until the patient's vital signs are below the above parameters.…”

Section: B Benzodiazepinesmentioning

confidence: 99%

“…In one study, atenolol was found actively to potentiate hallucinations and delirium in alcoholics undergoing withdrawal. 30,34,35 …”

Section: Beta-blockersmentioning

confidence: 99%

Pharmacotherapy in Alcoholism

Miller

1994

Alcoholism Treatment Quarterly

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Pharmacological Management of Alcohol Withdrawal

Mayo‐Smith¹

1997

JAMA

616

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Benzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost. Dosage should be individualized, based on withdrawal severity measured by withdrawal scales, comorbid illness, and history of withdrawal seizures. beta-Blockers, clonidine, carbamazepine, and neuroleptics may be used as adjunctive therapy but are not recommended as monotherapy.

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Propranolol-Associated Confused States during Alcohol Withdrawal

Cited by 20 publications

References 0 publications

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

Pharmacotherapy in Alcoholism

Pharmacological Management of Alcohol Withdrawal

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