RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-1729469
Opioid and/or Psychotropic Use Increases Intraprocedural Sedation Drug Requirements
![](https://www.thieme-connect.de/media/10.1055-s-00033348/202201/lookinside/thumbnails/10-1055-s-0041-1729469-1.jpg)
Abstract
Objectives Acute pain management in opioid users can be challenging in the perioperative period. This study focuses on whether use of opioids increases sedation medication requirements in patients undergoing port placement under moderate sedation.
Materials and Methods A retrospective review was performed on all patients undergoing port placement between June 1, 2017, and June 30, 2019. Exclusion criteria included receiving general anesthesia, no sedation, and errors in data entry. Data collection included demographics, use of opioids, benzodiazepines, antidepressants, tobacco, alcohol, and sedation data.
Results Opioid, benzodiazepine, and selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) use was significantly associated with higher sedation drug dose requirements. Patients using opioids required 10.5% higher doses of midazolam compared with nonusers. Benzodiazepine users required 16.3% additional dosage of midazolam than nonusers. Finally, patients on SSRIs/SNRIs medications required 11.8% higher midazolam dosing when compared with nonusers.
Conclusion Anticipating higher needs of sedation medications during procedures in patients with history of psychotropic agents use can allow for more effective sedation and patient satisfaction. More patient and provider awareness is needed on this topic, as health care policy is moving toward value-based healthcare, with patient satisfaction surveys being one of its indicators.
Publikationsverlauf
Artikel online veröffentlicht:
18. Mai 2021
© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Chou R. 2009 Clinical Guidelines from the American Pain Society and the American Academy of Pain Medicine on the use of chronic opioid therapy in chronic noncancer pain: what are the key messages for clinical practice?. Pol Arch Med Wewn 2009; 119 (7-8) 469-477
- 2 Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. [published correction appears in MMWR Recomm Rep. 2016;65(11):295] MMWR Recomm Rep 2016; 65 (01) 1-49
- 3 Volkow ND, McLellan AT. Opioid abuse in chronic pain–Misconceptions and mitigation strategies. N Engl J Med 2016; 374 (13) 1253-1263
- 4 Volkow N, Benveniste H, McLellan AT. Use and misuse of opioids in chronic pain. Annu Rev Med 2018; 69: 451-465
- 5 U.S. Opioid Prescribing Rate Maps. CDC. Available at https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html. Accessed September 25, 2020
- 6 Adesoye A, Duncan N. Acute pain management in patients with opioid tolerance. US Pharmacist 2017; 42(3): 28-32
- 7 Mitra S, Sinatra RS. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology 2004; 101 (01) 212-227
- 8 FDA. Extended-release (ER) and long-acting (LA) opioid analgesics Risk Evaluation and Mitigation Strategy (REMS). https://www.fda.gov/media/83883/download. Accessed September 25, 2020
- 9 Datto CJ, Hu Y, Wittbrodt E, Fine PG. Opioid utilization patterns among patients with cancer and non-cancer pain. J Opioid Manag 2019; 15 (01) 11-18
- 10 Moran TC, Kaye AD, Mai AH, Bok LR. Sedation, analgesia, and local anesthesia: a review for general and interventional radiologists. Radiographics 2013; 33 (02) e47-e60
- 11 Patel R, Clayton S, Quintero E, Gill J. chronic opioid users are more difficult to sedate than alcoholics and controls. South Med J 2015; 108 (12) 744-747
- 12 José RJ, Shaefi S, Navani N. Sedation for flexible bronchoscopy: current and emerging evidence. Eur Respir Rev 2013; 22 (128) 106-116
- 13 Soyka M. Treatment of benzodiazepine dependence. N Engl J Med 2017; 376 (12) 1147-1157
- 14 Lader M. Benzodiazepine harm: how can it be reduced?. Br J Clin Pharmacol 2014; 77 (02) 295-301
- 15 de Wit M, Wan SY, Gill S. et al Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation: a retrospective study. BMC Anesthesiol 2007; 7: 3
- 16 Osborn TM, Sandler NA. The effects of preoperative anxiety on intravenous sedation. Anesth Prog 2004; 51 (02) 46-51
- 17 Cancer Facts & Figures 2020. American Cancer Society. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf. Accessed September 25, 2020
- 18 Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996-2013. Am J Public Health 2016; 106 (04) 686-688
- 19 Cook PJ, Flanagan R, James IM. Diazepam tolerance: effect of age, regular sedation, and alcohol. Br Med J (Clin Res Ed) 1984; 289 (6441) 351-353
- 20 Vinkers CH, Olivier B. Mechanisms underlying tolerance after long-term benzodiazepine use: a future for subtype- selective GABA (A) receptor modulators?. Adv Pharmacol Sci 2012; 2012: 416864
- 21 Bateson AN. Basic pharmacologic mechanisms involved in benzodiazepine tolerance and withdrawal. Curr Pharm Des 2002; 8 (01) 5-21
- 22 Willems IA, Gorgels WJ, Oude RC Voshaar, Mulder J, Lucassen PL. Tolerance to benzodiazepines among long-term users in primary care. Fam Pract 2013; 30 (04) 404-410
- 23 Attri JP, Bala N, Chatrath V. Psychiatric patient and anaesthesia. Indian J Anaesth 2012; 56 (01) 8-13
- 24 Taylor C, Fricker AD, Devi LA, Gomes I. Mechanisms of action of antidepressants: from neurotransmitter systems to signaling pathways. Cell Signal 2005; 17 (05) 549-557
- 25 Suffeda A, Meissner W, Rosendahl J, Guntinas-Lichius O. Influence of depression, catastrophizing, anxiety, and resilience on postoperative pain at the first day after otolaryngological surgery: A prospective single center cohort observational study. Medicine (Baltimore) 2016; 95 (28) e4256
- 26 Pan X, Wang J, Lin Z, Dai W, Shi Z. Depression and anxiety are risk factors for postoperative pain-related symptoms and complications in patients undergoing primary total knee arthroplasty in the United States. J Arthroplasty 2019; 34 (10) 2337-2346