![]() Evaluation of the literature indicates that dexmedetomidine is associated with a decrease in short-term benzodiazepine requirements after initiation, and improvement in hemodynamic parameters in relation to the adrenergic drive present in alcohol withdrawal. A total of 13 published articles evaluating the efficacy and safety of dexmedetomidine as an adjunctive agent for the treatment of alcohol withdrawal in adult patients were identified from a MEDLINE search using the key words alcohol withdrawal, delirium tremens and dexmedetomidine. To review available literature supporting the use of adjunctive dexmedetomidine for management of severe alcohol withdrawal syndrome. Understanding of recent literature evaluating its use is necessary for appropriate selection. Dexmedetomidine, an Î☒-agonist, serves as a potential adjunctive agent through management of associated autonomic symptoms. Despite escalating doses of benzodiazepines, published literature indicates that some patient's alcohol withdrawal syndrome symptoms do not respond, and that the use of adjunctive agents may be beneficial in these patients. The primary management of alcohol withdrawal involves the administration of a γ-aminobutyric acid agonist, such as benzodiazepines, for management of symptoms and to prevent further progression to seizure or delirium tremens. Wong, Adrian Smithburger, Pamela L Kane-Gill, Sandra L Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome. A potential role for opiates in managing severe baclofen withdrawal is proposed. To date, the literature has not discussed the potential role for opiates in managing baclofen withdrawal, yet a growing body of literature is examining the interplay between opiates and gamma-aminobutyric acid B pathways. Typical management of baclofen withdrawal is reviewed. She was eventually weaned off sedating medications and returned to baseline functional status. Her pump was eventually replaced on hospital day 56 and within 24 hours her symptoms dramatically improved. She subsequently developed a severe, prolonged baclofen withdrawal syndrome marked by increased spasticity, agitation, hypertension, and tachycardia that lasted nearly 2 months, requiring intensive care and continuous intravenous sedation with benzodiazepines and opiates. We report the case of an 11-year-old girl with spastic quadriplegic cerebral palsy who developed an infected pump and subsequent meningitis, prompting the removal of her pump and catheter. Cases of withdrawal lasting greater than 1 or 2 weeks, however, are sparse. ITB withdrawal varies widely in its severity and poses the very real possibility of death if not promptly managed. Intrathecal baclofen (ITB) withdrawal is a well-recognized complication when drug delivery is disrupted for any reason. Hansen, Colby R Gooch, Judith L Such-Neibar, Teresa Prolonged, severe intrathecal baclofen withdrawal syndrome: a case report. ![]()
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