원내 외과계 중환자실 재원 환자의 마약성 진통제 tapering현황 분석 (Tapering of Opioid Analgesics Injected to the Patients Hospitalized in Surgical Intensive Care Unit)

서지정보

· 발행기관 : 한국병원약사회
· 수록지 정보 : 병원약사회지 / 29권 / 4호 / 384 ~ 393페이지
· 저자명 : 이경아, 김수희, 조주희, 안지현, 손은선, 김성은, 석현주

초록

Opioid analgesics strongly act on opioid receptors without any ceiling effect*.
However, if such modality suddenly stops, it represents dependence and withdrawal symptoms.
Therefore, this drug should be tapered to quit. In the intensive care unit where patients from moderate to severe pain are hospitalized, opioid analgesics are widely used for adequate pain control and sedation.
At the Severance Hospital’s ICU, there is opioid analgesic protocol that includes fixed dilution rate and the fixed initial dose. However, for matters related to drug discontinuation, they are entirely determined by the clinical decision. As such, there are many occasions when the reinitiating of the opioid analgesics is needed due to withdrawal symptoms. Therefore, this study investigated the tendency of tapering opioid analgesics used in surgical intensive care unit (SICU). This study is targeting patients who were hospitalized at the Severance Hospital’s SICU and were treated with opioid analgesics for more than 3 days during March 1st ~ August 31st of 2011. Patients under the age of 7 were excluded. A total of 147 patients’opioid analgesic tapering trends were analyzed via medical records and clinical observation records. The frequency of opioid analgesics used at the Severance Hospital SICU appeared to be as follows: Fentanyl 114 cases (78.1%), Remifentanyl 29 cases (19.9%) and Morphine 3 cases (2.1 %). According to the result, tapering was applied in 86 cases (59.6%). The number of each drug applied to tapering was Fentanyl 68 cases (59.7%), Remifentanyl 16 cases (55.2%) and Morphine 2 cases (66.7%). The median value of medication days and the mean dose tended to be high in the tapering group. The median tapering time of each drug was as follows: Fentanyl 46 hour, Remifentanyl 29.5 hour and Morphine 114 hour.
A number of cases that occur re-administration of opioid analgesics among the non-tapering group was as follows: Fentanyl 28 cases (60.9%) and Remifentanyl 9 cases (69.2%). Morphine was not re-administrated because the patient died during Morphine was administered. Moreover, the incidence of withdrawal syndrome among the non-tapering group was as follows: Fentanyl 22 cases (47.8%), and Remifentanyl 4 cases (30.8%). Therefore, this study emphasizes the pharmacists’role of mediating inappropriate drug discontinuation and encourages appropriate drug use through the survey.
* Ceiling effect : referring to the level at which an independent variable no longer has an effect on a dependent variable.

영어초록

Opioid analgesics strongly act on opioid receptors without any ceiling effect*.
However, if such modality suddenly stops, it represents dependence and withdrawal symptoms.
Therefore, this drug should be tapered to quit. In the intensive care unit where patients from moderate to severe pain are hospitalized, opioid analgesics are widely used for adequate pain control and sedation.
At the Severance Hospital’s ICU, there is opioid analgesic protocol that includes fixed dilution rate and the fixed initial dose. However, for matters related to drug discontinuation, they are entirely determined by the clinical decision. As such, there are many occasions when the reinitiating of the opioid analgesics is needed due to withdrawal symptoms. Therefore, this study investigated the tendency of tapering opioid analgesics used in surgical intensive care unit (SICU). This study is targeting patients who were hospitalized at the Severance Hospital’s SICU and were treated with opioid analgesics for more than 3 days during March 1st ~ August 31st of 2011. Patients under the age of 7 were excluded. A total of 147 patients’opioid analgesic tapering trends were analyzed via medical records and clinical observation records. The frequency of opioid analgesics used at the Severance Hospital SICU appeared to be as follows: Fentanyl 114 cases (78.1%), Remifentanyl 29 cases (19.9%) and Morphine 3 cases (2.1 %). According to the result, tapering was applied in 86 cases (59.6%). The number of each drug applied to tapering was Fentanyl 68 cases (59.7%), Remifentanyl 16 cases (55.2%) and Morphine 2 cases (66.7%). The median value of medication days and the mean dose tended to be high in the tapering group. The median tapering time of each drug was as follows: Fentanyl 46 hour, Remifentanyl 29.5 hour and Morphine 114 hour.
A number of cases that occur re-administration of opioid analgesics among the non-tapering group was as follows: Fentanyl 28 cases (60.9%) and Remifentanyl 9 cases (69.2%). Morphine was not re-administrated because the patient died during Morphine was administered. Moreover, the incidence of withdrawal syndrome among the non-tapering group was as follows: Fentanyl 22 cases (47.8%), and Remifentanyl 4 cases (30.8%). Therefore, this study emphasizes the pharmacists’role of mediating inappropriate drug discontinuation and encourages appropriate drug use through the survey.
* Ceiling effect : referring to the level at which an independent variable no longer has an effect on a dependent variable.

참고자료

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