"improving intensive care in Scotland"

Anti-dopaminergics

  • Anti-dopaminergics are not recommended as first line sedatives for patients in ICU.

  • They are recommended, however, as the first line treatment of delirium and are therefore indicated where delirium co-exists. Delirium has been found to be present in 30-80% of mechanically-ventilated critically ill patients.

  • The most commonly used agent by far is haloperidol, though chlorpromazine and olanzapine are also used.

  • The anti-dopaminergics produce a neuroleptic state, characterised by reduced motor activity, anxyiolysis and indifference to the environment.

  • They have the advantage of avoiding respiratory depression, but provide no amnesia or analgesia and may make neurological assessment and the subjective assessment of patient's pain and sedation more difficult.

  • Other side-effects include: hypotension, QT prolongationventricular arrhythmias (including torsade de pointes with an incidence of up to 3.6%) and extrapyramidal effects (e.g. dystonias, akathisia, parkinsonism, neuroleptic malignant syndrome).

  • Serial ECGs should be performed to monitor for changes.

  • The optimal haloperidol dosing regimen has not been clearly defined.

  • A suggested regimen is to titrate intravenous doses of 1-2.5mg every 15 minutes until the desired effect is achieved then divide the total dose into four 6-hourly doses with additional doses as required.

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