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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 March;67(3):97-105

language: English

Use of sedative and analgesic drugs in the first week of ICU stay. A pharmaco-epidemiological perspective

Bertolini G. 1, Melotti R. 2, Romano P. 3, Cattaneo A. 1, Mura G. 1, Ruggiata R. 1, Ravizza A. 4, Brazzi L. 5, Iapichino G. 6

From the
1 Istituto di Ricerche Farmacologiche “Mario Negri”: Centro di Ricerche Cliniche per le Malattie Rare “Aldo e Cele Daccò” Ranica (Bergamo) Laboratorio di Ricerche Cliniche Oncologiche, Milano
2 Dipartimento di Scienze Chirurgiche e Anestesiologiche Università degli Studi Bologna
3 SPA Società Prodotti Antibiotici S.p.A. Direzione Medica, Milano (at the time of the study: Zeneca S.p.A., Milano)
4 Servizio di Anestesia e Rianimazione Ospedale Niguarda Ca’ Granda, Milano
5 Istituto di Anestesia e Rianimazione Ospedale Maggiore IRCCS, Milano
6 Servizio Anestesia e Rianimazione Azienda Ospedaliera S. Paolo, Milano


Aim. To ­assess the cur­rent prac­tice of phar­mac­o­log­i­cal seda­tion and anal­ge­sia in ­patients admit­ted in Ital­ian inten­sive ­care ­units.
Meth­ods. ­Design: obser­va­tion­al, pros­pec­tive, ­cohort ­study, involv­ing all ­patients admit­ted dur­ing a one-­month peri­od to par­tic­i­pat­ing Cen­ters in 1994. All ­patients ­were fol­lowed-up for ­vital stat­us ­until dis­charge and eval­u­at­ed for phar­mac­o­log­i­cal seda­tion and anal­ge­sia for the ­first ­week of ICU ­stay. Set­ting: 128 Ital­ian, ­adult, gen­er­al, inten­sive ­care ­units, approx­i­mate­ly rep­re­sent­ing 1/3 of all Ital­ian ­Units. ­Patients: 2932 ­patients ­were ana­lyzed. ­They gen­er­at­ed 22612 ­patient-­days of inten­sive ­care ­unit ­stay, 11221 of ­which ­were eval­u­at­ed.
­Results. A ­total of 31 dif­fer­ent sed­a­tive ­drugs ­were ­used in 1751 ­patients. On 64% of sedat­ed ­days ­only one ­drug was uti­lized, where­as two or ­more ­drugs ­were admin­is­tered in the remain­ing ­days. Pro­pof­ol was the ­most wide­ly pre­scribed ­drug, fol­lowed by fen­ta­nyl and diaz­e­pam, ­while mor­phine account­ed for 14.8% of sedat­ed ­days. The anal­y­sis of the pat­tern of seda­tion ­over ­time ­revealed a ­trend to lin­e­ar­ly ­reduce the use of ­this prac­tice.
Con­clu­sions. Our ­results ­depict a rel­a­tive­ly low prev­a­lence of seda­tion in Ita­ly, ­with the use of ­large num­ber of dif­fer­ent ­agents. We ­also ­observed a larg­er ­than expect­ed use of ­some ­drugs, ­like pro­pof­ol and fen­ta­nyl, ­that ­could be due to the unavail­abil­ity of new sed­a­tive and anal­ge­sic ­drugs in Ita­ly on 1994. In con­clu­sion, Ital­ian inten­si­vists ­seem to be ­very con­ser­va­tive ­about the prac­tice of phar­mac­o­log­i­cal seda­tion in crit­i­cal­ly ill ­patients

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