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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today’s tip is about benzodiazepine addiction in ICU, or even after ICU. And also opiate addiction in ICU or after ICU.

So, many patients in intensive care that are in an induced coma and are on sedation , often end up on benzodiazepine, such as midazolam or Versed as the most prominent one being used in intensive care. On top of that, they’re also often on morphine or fentanyl, which are opiates. Both medications are needed when someone is in an induced coma, on a ventilator with a breathing tube, or an endotracheal tube in their mouth.

Now, we have done multiple articles and videos about that topic when someone is in an induced coma and on a ventilator. So have a look on our website at intensivecarehotline.com and use the search box if you wanted to find out more about those topics.

Now, the issues that I want to focus on today, is simply what happens when patients come out of the induced coma and have been on prolonged benzodiazepine, such as midazolam or Versed or, and/or morphine and fentanyl. Because when patients come out of an induced coma, they often go through a withdrawal process because again, benzodiazepines are addictive and so are morphine or fentanyl.

Now, when patients then wake up after an induced coma, they might appear to be confused, agitated, sometimes even be aggressive. Sometimes they can be what’s being referred to as pleasantly confused. But they might also go through severe withdrawals because they’ve been used for so long to the benzodiazepines and/or the morphine or fentanyl. So how do you counteract that?

Well, number one, you wean it off gradually, you just don’t switch it off. You just go from five milligrams an hour of midazolam or Versed to zero then you wean it off. Gradually, you go down to four milligrams an hour. Next day, or after a few hours you go down to three milligrams an hour and so forth, the same applies to fentanyl or morphine.

Other things you can do, especially with pain relief, you can introduce other pain killers that are less potent than fentanyl or morphine or other opiates. You can introduce stuff like Panadol or paracetamol. You can also introduce some non-steroidal pain killers. So there’s a variety of things you can do to wean patients off the opiates so that they’re not going through withdrawal.

Now, if the withdrawal continues, you can introduce medications such as clonidine. Or sometimes you can also introduce dexmedetomidine, also known as Precedex to get rid of the benzodiazepines and opiates. Precedex or dexmedetomidine can replace both sedative and pain relief.

Now, other issues that can happen when someone has been on benzodiazepines or opiates for too long is they can also go through an ICU psychosis or ICU delirium, and that is much more difficult to handle. And people go through depression  often, and it’s not very nice to watch the best cure for those people is to get out of ICU as quickly as possible if they can on a clinical level to get back to “normality” as quickly as possible. Get back to normality, daylight, fresh air, eating, drinking, back home, if that is possible at all. That’s the quickest way to treat those issues.

That is my quick tip for today.

Now I should also mention that, if you can avoid, especially the benzodiazepines for an induced coma and you can use propofol, for example, also known as Diprivan, or you can use dexmedetomidine also known as Precedex. That is probably the best case scenario. So you’re not getting into those addictive situations in the first place, but that’s not always possible because sometimes dexmedetomidine, or Precedex, I have seen, is not working on patients. And then you got to revert back to the benzodiazepine and opiate option.

So that’s my quick tip for today.

Like this video, share it with your friends and families, subscribe to my YouTube channel  for updates for families in intensive care, comment below what questions you have or what you want to see next, and click the notification bell.

If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or send us an email to [email protected].

Also have a look at our membership for families in intensive care at intensivecaresupport.org.

And if you need a medical record review , click on the link and we can help you with reviewing your loved one’s medical records while they’re in ICU. I also provide one-to-one consulting and advocacy for families in intensive care. Again, you can book a time with me by clicking on the schedule appointment button on the top of the website.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will see you in a few days.