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OBJECTIVE: To determine whether the dose of narcotics and benzodiazepines is associated with length of time from mechanical ventilation withdrawal to death in the setting of withdrawal of life-sustaining treatment in the ICU. DESIGN: Retrospective chart review. SETTING: University-affiliated, level I trauma center. PATIENTS: Consecutive critically ill patients who had mechanical ventilation withdrawn and subsequently died in the ICU during two study time periods. RESULTS: There were 75 eligible patients with a mean age of 59 years. The primary ICU admission diagnoses included intracranial hemorrhage (37%), trauma (27%), acute respiratory failure (27%), and acute renal failure (20%). Patients died during a median of 35 min (range, 1 to 890 min) after ventilator withdrawal. On average, 16.2 mg/h opiates in morphine equivalents and 7.5 mg/h benzodiazepine in lorazepam equivalents were administered during the time period starting 1 h before ventilator withdrawal and ending at death. There was no statistically significant relationship between the average hourly narcotic and benzodiazepine use during the 1-h period prior to ventilator withdrawal until death, and the time from ventilator withdrawal to death. The restriction of medication assessment in the last 2 h of life showed an inverse association between the use of benzodiazepines and time to death. For every 1 mg/h increase in benzodiazepine use, time to death was increased by 13 min (p = 0.015). There was no relationship between narcotic dose and time to death during the last 2 h of life (p = 0.11). CONCLUSIONS: We found no evidence that the use of narcotics or benzodiazepines to treat discomfort after the withdrawal of life support hastens death in critically ill patients at our center. Clinicians should strive to control patient symptoms in this setting and should document the rationale for escalating drug doses. [ABSTRACT FROM AUTHOR]

Eletriptan is a new serotonin 5-HT[1B/10] receptor agonist deemed approvable by the FDA for the acute treatment of migraine. This oral agent offers increased bioavailability, lipophilicity, and CNS penetration over other triptan analogues. These unique pharmacokinetic characteristics may be responsible for the rapid onset of effect with this agent. Clinical trials comparing eletriptan with placebo have consistently demonstrated efficacy in headache response rates at both 1 and 2 hours. Additionally, comparative clinical trials have shown eletriptan to have a more rapid onset of effect and a higher rate of therapeutic response compared with sumatriptan. Though increased adverse effects are associated with higher doses of eletriptan, it maintains a higher patient preference over sumatriptan. [ABSTRACT FROM AUTHOR]