Alcohol withdrawal syndrome; a brief review on sedation of the agitated delirious patient.

1. Alcohol Withdrawal Syndrome
Sedation
javier benitez (@jvrbntz)
In 5 slides or less...

2. Case Presentation
A middle age man with multiple comorbidities
including previous ICU admissions for AWS
with delirium tremens. He is in the hospital
this time with AWS and agitation difficult to
control.
Discuss the progression of sedative agents that
may be used in agitated patients with severe
delirium?

3. ● Progressively IV bolus of benzodiazepines or
barbiturates
– Associated with decrease length of stay, mechanical
ventilation, pneumonia in not severely agitated
– Phenobarb: narrow therapeutic window, long half-life
● Titrated IV infusion of benzodiazepines
– Consider in more severe agitated patients,especially if
sedation was not achieved with IV bolus
● Addition of IV rescue to #1 or #2
– Propofol: risks of hypotension, bradycardia, propofol
infusion syndrome
– Dexmedetomedine: a agonist > clonidine, less delirium
●
These meds have the risk of respiratory depression

4. Reference
Alcohol Withdrawal Syndrome
Richard W. Carlson, MD, PhD, Nivedita N. Kumar, MD, Edna Wong-
Mckinstry, MD, Srikala Ayyagari, MD, Nitin Puri, MD, Frank K. Jackson,
Shivaramaiah Shashikumar, MD
Critical Care Clinics, Volume 28, Issue 4 , Pages 549-585, October 2012