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Drugs for amnesia in the ICU
B K Wagner1, D A O'Hara, J S Hammond
1College of Pharmacy, Rutgers University, Piscataway, NJ, USA.
Summary
Pharmacological agents can alter patient recall of intensive care unit (ICU) stays. Benzodiazepines, particularly lorazepam and midazolam, are most effective for inducing amnesia in ICU patients.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Neuroscience
Background:
- Patient recall of intensive care unit (ICU) stays can be influenced by various factors, including pharmacological interventions.
- Understanding the amnestic effects of commonly used ICU medications is crucial for managing patient memory and experience.
Observation:
- A comprehensive review of clinical trials (1966-1995) examined the impact of various drugs on patient memory in the ICU.
- Benzodiazepines, especially lorazepam and midazolam, demonstrated potent amnestic effects.
- Propofol and ketamine showed dose-dependent effects on memory, while opioids generally did not induce amnesia unless at high doses or in organ failure.
Findings:
- Benzodiazepines reliably induce anterograde amnesia, crucial for preventing recall of distressing ICU experiences.
- Lorazepam and midazolam are preferred due to their pharmacokinetic profiles.
- Propofol and ketamine's amnestic effects are concentration-dependent, requiring careful titration.
- Certain agents like barbiturates, haloperidol, antihistamines, and anticholinergics without CNS penetration did not impair memory in non-critically ill patients.
Implications:
- Pharmacological strategies, particularly the judicious use of benzodiazepines, can significantly reduce or prevent recall of ICU stays.
- Tailoring drug selection based on patient condition and desired amnestic effect is essential.
- Further research into optimizing drug regimens for memory management in critical care is warranted.