When given long-term, patients may show elevations in serum triglycerides, amylase, and lipase. In extreme cases, a chemical pancreatitis may occur. Patients treated with long-term propofol infusion may experience a prolonged awakening, but this is much less pronounced than that seen with the benzodiazepines. Propofol is expensive, but because of its other advantages, its use may ultimately reduce the overall cost of care. The recognition of pain and discomfort in the ICU patient can be difficult, particularly when MODS is involved.
Narcotic analgesics are often combined with sedative drugs to control patient agitation.
Because the effect is additive, the doses of both drugs may be reduced. Commonly used narcotic analgesics are morphine and fentanyl, but there are several precautions to consider. In patients with hepatic dysfunction, prolonged elimination or decreased metabolism of fentanyl may occur. It may be useful in the patient with end organ dysfunction secondary to its mechanism of metabolism. The need for sedatives and analgesics in the MODS patient has historically been based on the degree of agitation exhibited by the patient.