Articles: hypnotics-sedatives-adverse-effects.
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Review Meta Analysis
What is the level of evidence for the amnestic effects of sedatives in pediatric patients? A systematic review and meta-analyses.
Studies have suggested that benzodiazepines are amnestic drug par excellence, but when taken together, what level of evidence do they generate? Are other sedatives as amnestic as benzodiazepines? The aim of this study was to assess the level of scientific evidence for the amnestic effect of sedatives in pediatric patients who undergo health procedures. ⋯ In children, moderate evidence support that benzodiazepines induce anterograde amnesia, whereas the evidence for other sedatives is weak and based on isolated and small studies. Further clinical trials focused on the amnesia associated with non-benzodiazepine sedatives are therefore needed.
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Aust N Z J Psychiatry · Jun 2016
Review Meta AnalysisMortality associated with anxiolytic and hypnotic drugs-A systematic review and meta-analysis.
Use of hypnotics or anxiolytic drugs is common and various studies have reported increased mortality with hypnotics or anxiolytic use. ⋯ This meta-analysis suggests that hypnotics or anxiolytics drugs use is associated with increased mortality and hence should be used with caution. Future studies focused on underlying mechanism of increased mortality with hypnotics or anxiolytics use are required.
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Cochrane Db Syst Rev · Jul 2015
Review Meta AnalysisEffects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea.
Obstructive sleep apnoea (OSA) is a common sleep disorder characterised by partial or complete upper airway occlusion during sleep, leading to intermittent cessation (apnoea) or reduction (hypopnoea) of airflow and dips in arterial oxygen saturation during sleep. Many patients with recognised and unrecognised OSA receive hypnotics, sedatives and opiates/opioids to treat conditions including pain, anxiety and difficulty sleeping. Concerns have been expressed that administration of these drugs to people with co-existing OSA may worsen OSA. ⋯ The findings of this review show that currently no evidence suggests that the pharmacological compounds assessed have a deleterious effect on the severity of OSA as measured by change in AHI or ODI. Significant clinical and statistical decreases in minimum overnight SpO2 were observed with remifentanil, zolpidem 20 mg and triazolam 0.25 mg. Eszopiclone 3 mg and sodium oxybate 4.5 g showed a beneficial effect on the severity of OSA with a reduction in AHI and may merit further assessment as a potential therapeutic option for a subgroup of patients with OSA. Only one trial assessed the effect of an opioid (remifentanil); some studies included CPAP treatment, whilst in a significant number of participants, previous treatment with CPAP was not stated and thus a residual treatment effect of CPAP could not be excluded. Most studies were small and of short duration, with indiscernible methodological quality.Caution is therefore required when such agents are prescribed for patients with OSA, especially outside the severity of the OSA cohorts and the corresponding dose of compounds given in the particular studies. Larger, longer trials involving patients across a broader spectrum of OSA severity are needed to clarify these results.
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Cochrane Db Syst Rev · Jan 2015
Review Meta AnalysisSingle induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.
The use of etomidate for emergency airway interventions in critically ill patients is very common. In one large registry trial, etomidate was the most commonly used agent for this indication. Etomidate is known to suppress adrenal gland function, but it remains unclear whether or not this adrenal gland dysfunction affects mortality. ⋯ Although we have not found conclusive evidence that etomidate increases mortality or healthcare resource utilization in critically ill patients, it does seem to increase the risk of adrenal gland dysfunction and multi-organ system dysfunction by a small amount. The clinical significance of this finding is unknown. This evidence is judged to be of moderate quality, owing mainly to significant attrition bias in some of the smaller studies, and new research may influence the outcomes of our review. The applicability of these data may be limited by the fact that 42% of the patients in our review were intubated for "being comatose", a population less likely to benefit from the haemodynamic stability inherent in etomidate use, and less at risk from its potential negative downstream effects of adrenal suppression.
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Meta Analysis
The effect of non-benzodiazepine hypnotics on sleep quality and severity in patients with OSA: a meta-analysis.
Although there is a high co-occurrence of insomnia and obstructive sleep apnea (OSA), the administration of sedative hypnotics in patients with OSA is still inconsistent. The aim is to study the effect of non-benzodiazepine hypnotics (non-BZDs) on sleep quality and severity in patients with OSA. ⋯ The administration of non-BZDs at the commonly recommended dose has been shown to improve objective sleep quality in OSA patients without worsening sleep apnea. It suggests that OSA patients with a complaint of insomnia symptoms may benefit from taking non-BZDs.