Sederende medicatie bij de geriatrische intensivecarepatient

The number of elderly patients admitted to Intensive Care Units (ICUs) has increased significantly in recent years. It has been demonstrated that the elderly are more prone to inadequate drug treatment and adverse drug effects. OBJECTIVE To perform a literature review on the effects of aging on pharmacokinetic and pharmacodynamic properties of commonly used sedative drugs in Dutch ICUs. DESIGN AND METHODS Literature review using PubMed. RESULTS Literature on the effects of aging on the pharmacology of commonly used sedative drugs in the ICU is scarce. For the general population, we found that for midazolam, propofol, fentanyl and remifentanil aging is associated with an increased susceptibility of the patients for the pharmaco-dynamic properties of these agents. This effect is confirmed for some of these drugs in ICU patients. In addition, a reduction in drug clearance was observed for propofol and remifentanil. CONCLUSION Based on these findings, we suggest to start with lower dosages for midazolam, propofol, fentanyl and remifentanil in elderly ICU patients and to re-evaluate frequently and adjust the therapy by clinical effect if necessary.