Review Article
Volume 9 Issue 1 - 2021
Appropriate Therapeutic Interventions for ICU Disorders Relating to Pain Relief, Sedations, and Psychological Disturbances
Duraiyah Thangathurai* and Maggy Riad
Department of Anesthesiology, University of Southern California, USA
*Corresponding Author: Duraiyah Thangathurai, Department of Anesthesiology, University of Southern California, USA.
Received: September 29, 2020; Published: December 30, 2020


Surgical ICU patients often experience myriad ICU-related symptoms that accompany their primary diagnosis. Pain, anxiety, sleep disturbance, sleep deprivation, agitation, confusion, delirium, complications associated with polypharmacy are just a few examples. Pharmacological therapy prescribed by intensivists to manage some of these symptoms is itself not without side effects. This makes symptom control and relief in the ICU a very complex problem that needs to be individualized for each patient using a multi-modal approach. In this paper we will present an overview of some of the problematic areas in the evaluation and management of the critically sick ICU patients, and will address some of the pertinent, and sometimes easily overlooked, problems associated with the different ICU treatment modalities that are commonly applied.

Keywords: Delirium; Sleep Deprivation; Pain; Depression; Narcotics


  1. Holland J., et al. “The ICU syndrome; Fact or fancy”. Psychiatric Medication 4 (1973): 241-249.
  2. Asbury AJ. “Patients’ memories and reactions to intensive care”. Critical Care Ill 1 (1985): 12-13.
  3. Kehlet H. “Pain relief and modification of the stress response”. Critical Care Medicine Critical Care 8 (1986): 49-75.
  4. Phillips GD and Cousins MJ. “Neurological mechanisms of pain and the relationship of pain anxiety and sleep”. Critical Care Medicine Critical Care 8 (1986): 21-48.
  5. Campbell IT., et al. “Are circadian rhythms important in intensive care?” Intensive and Critical Care Nursing 1 (1986): 144-150.
  6. Moore-Ede MC., et al. “Circadian timekeeping in health and disease. Part I. Basic properties of circadian pacemakers”. The New England Journal of Medicine 309 (1983): 469-476.
  7. Adam K and Oswald I. “Protein synthesis, bodily renewal and the sleep-wake cycle”. Clinical Science 65 (1983): 561-567.
  8. Baxter S. “Psychological problems of intensive care”. British Journal of Hospital Medicine 11 (1974): 875-885.
  9. Bowden P. “Psychiatric aspects of intensive care”. in Tinker J, Rapin M (edITIONs): Care of the Critically Ill. Berlin, Germany, Springer-Verlag (1983): 787-797.
  10. Strain JJ. “Psychological reactions to acute medical illness and critical care”. Critical Care Medicine 6 (1978): 39-44.
  11. Marks RM and Sacher EJ. “Undertreatment of medical inpatients with narcotic analgesics”. Annals of Internal Medicine 78 (1973): 173-181.
  12. Dasta JF., et al. “Pattern of prescribing and administering drugs for agitation and pain in a surgical intensive care unit”. Critical Care Medicine 22 (1994): 974-980.
  13. Cronin M and Redfern PA. “Psychiatry and post-operative pain complaints in surgical patients”. British Journal of Anaesthesia 45 (1973): 879-886.
  14. Tittle M and McMillian SC. “Pain and pain-related side effects in an ICU and on a surgical unit: Nurses’ management”. The American Journal of Critical Care's 3 (1994): 25-30.
  15. Maxam-Moore VA., et al. “Analgesics for cardiac surgery patients in critical care: Describing current practice”. The American Journal of Critical Care's 3 (1994): 31-39.
  16. Aurell J and Elmqvist D. “Sleep in surgical intensive care unit”. British Medical Journal 290 (1985): 1029-1032.
  17. Adam K and Oswald I. “Sleep helps healing”. BMH 289 (1984): 1400-1440.
  18. Wollschlager CM., et al. “Common complications in critically ill patients”. Disease-a-Month 34 (1988): 221-293.
  19. Easton C and MacKenzie F. “Sensory-perceptual alterations: Delirium in the intensive care unit”. Heart Lung 17 (1988): 229-237.
  20. Bronheim HE., et al. “Depression in the intensive care unit”. Critical Care Medicine 13 (1985): 985-988.
  21. Brock-Utne JG., et al. “Psychiatric problems in intensive care”. Anaesthesia 31 (1976): 380-384.
  22. Dobb GJ and Murphy DF. “Sedation and analgesia during intensive care”. Journal of Clinical Anesthesiology 3 (1985): 1055-1085.
  23. Cook B and Spence AA. “Post-operative central anticholinergic syndrome”. European Journal of Anaesthesiology 14 (1997): 1-2.
  24. Rupreht J and Dworacek B. “The central anticholinergic syndrome in the postoperate period”. in Nunn JF, Utting JE, Brown BR (editions): General Anaesthesia. London, UK, Butterworths (1989): 1141-1148.
  25. Torline RL. “Central anticholinergic syndrome following reversal of neuromuscular blockade”. Anesthesiology Review 20 (1993): 47-50.
  26. Sun KO. “Central anticholinegic syndrome following reversal of neuromuscular blockade”. Anaesthesia and Intensive Care Medicine 21L (1993): 363-365.
  27. Horowitz MJ. “Stress-response syndromes. A review of posttraumatic stress and adjustment disorders”. in Wilson JP, Raphael B (editions): International Handbook of Traumatic Stress Syndromes”. New York, NY, Plenum (1993): 49-60.
  28. Gersons BPR. “Post-traumatic stress disorder: The history of a recent concept”. British Journal of Psychiatry 161 (1992): 742-748.
  29. Davidson JRT and Foa EB. “Diagnostic issues in posttraumatic stress disorder: Considerations for the DSM-IV”. Journal of Abnormal Psychology 100 (1991): 346-355.
  30. Macleod AD and Maycock E. “Awareness during anesthesia and post traumatic stress disorder”. Anaesthesia and Intensive Care Medicine 20 (1992): 378-382.
  31. Schelling G., et al. “Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome”. Critical Care Medicine 26 (1998): 651-659.
  32. Hantson P., et al. “Withdrawal syndrome following midazolam infusion”. Intensive Care Medicine 21 (1995): 190-191.
  33. Shafer A., et al. “Use of fentanyl infusion in the intensive care unit: Tolerance to its anesthetic effects?” Anesthesiology 59 (1983): 245-248.
  34. Buck M and Blumer J. “Opioids and other analgesics: Adverse effects in the intensive care unit”. Critical Care Clinics 7 (1991): 615-637.
  35. Katz R., et al. “Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion”. Critical Care Medicine 22 (1994): 763-767.
  36. Cammarano WB., et al. “Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients”. Critical Care Medicine 26 (1998): 676-684.
  37. Gopinathan V. “Central anticholinergic syndrome - a forgotten entity”. British Journal of Anaesthesia 101 (2008).
  38. Katsanoulas K., et al. “Undiagnosed central anticholinergic system may lead to dangerous complications”. European Journal of Anaesthesiology 16 (1999): 803-809.
  39. Jackson JC., et al. “Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: Assessing the magnitude of the problem”. Critical Care Medicine 11 (2007): R27.
  40. Azoulay E., et al. “Risk of post-traumatic stress symptoms in family members of intensive care unit patients”. American Journal of Respiratory and Critical Care Medicine 171 (2005): 987-994.
  41. Fudickar A., et al. “Propofol infusion syndrome in anaesthesia and intensive care medicine”. Current Opinion in Anesthesiology 4 (2006): 404-410.
Citation: Duraiyah Thangathurai and Maggy Riad. “Appropriate Therapeutic Interventions for ICU Disorders Relating to Pain Relief, Sedations, and Psychological Disturbances”. EC Pharmacology and Toxicology 9.1 (2021): 33-40.

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