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  • © 2021

Opioid Use in Critical Care

A Practical Guide

  • Features algorithms and step-by-step approaches on how to navigate the balance between the relief of suffering and the adverse effects of opioids
  • Includes over 200 high-yield illustrations, photographs, and tables
  • Written by experts in the field

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Table of contents (16 chapters)

  1. Front Matter

    Pages i-x
  2. The Epidemiology of Opioids in Critical Illness

    • Timothy G. Gaulton
    Pages 1-15
  3. Assessment of Pain in the Intensive Care Unit

    • Athir H. Morad, Robert D. Stevens
    Pages 17-30
  4. Pharmacology and Pharmacokinetics of Opioids in the ICU

    • Jessica R. Crow, Stephanie L. Davis, Andrew S. Jarrell
    Pages 31-64
  5. Opioid Drug Interactions

    • Amy L. Dzierba, Teresa Poon, Justin Muir
    Pages 65-82
  6. Side Effects of Opioid Analgesic Therapy

    • Dane Scantling, Niels D. Martin
    Pages 83-97
  7. Rational Selection and Utilization of Opioid Analgesics in Critical Care

    • Christina Boncyk, Kyle Bruns, Christina J. Hayhurst, Christopher G. Hughes
    Pages 99-112
  8. Monitoring of Opioid Analgesic Use and Its Effects in Acute Care

    • Akhil Patel, Kunal Karamchandani, Ashish K. Khanna
    Pages 113-128
  9. Opioid-Induced Tolerance and Opioid-Induced Hyperalgesia in Critical Illness

    • Edward A. Bittner, Rachel Steinhorn, J. A. Jeevendra Martyn
    Pages 129-145
  10. Interaction of Opioids with Sedative Practices in the ICU

    • Jane Keating, Sandra L. Kane-Gill, Lewis J. Kaplan
    Pages 147-164
  11. Acute Pain Management in Patients with Opioid Dependence

    • Arthur Kitt, Andrew Kim
    Pages 165-185
  12. Management of Opioid Overdoses

    • Matthew Niehaus, Nicholas Goodmanson, Lillian Emlet
    Pages 187-194
  13. Use of Opioid Analgesics in Postsurgical and Trauma Patients

    • Daniel R. Brown, Mark R. Pedersen
    Pages 195-212
  14. Long-Term Effects of Pain and Opioid Use in the ICU

    • Mary Ann Hernando, Mark E. Mikkelsen
    Pages 213-221
  15. Special ICU Populations: Opioids in Neurocritical Care

    • Meghan M. Caylor, Ramani Balu
    Pages 223-245
  16. Opioid Use in the Critically Ill Geriatric Patient

    • Marie-France Forget, Han Ting Wang
    Pages 247-264
  17. Opioid Use in the Critically Ill Obstetric Patient

    • Charles Prior, Anthony Chau
    Pages 265-280
  18. Back Matter

    Pages 281-287

About this book

This book provides a concise yet comprehensive overview on the use of opioids in the ICU, offering practical, real-world recommendations on opioid utilization and alternative therapies. The text explains the physiology and assessment of pain and the need for analgesia in the ICU, details the pharmacology of opioids and their use in providing analgesia, sedation, and comfort for patients during critical illness, and summarizes advanced pharmaceutical and surgical approaches to pain management and procedural applications that can supplement, minimize, or replace opioids for the ICU patient. The book also includes algorithms and step-by-step approaches on navigating the delicate balance between the relief of suffering and the adverse effects of opioids, as well as a dedicated section on the management of critically ill patients with preexisting opioid tolerance. 



Written by experts in the field, Opioid Use in Critical Care: A Practical Guide is a valuable resource for ICU providers who treat and manage critically ill patients with opioids.

Editors and Affiliations

  • Professor of Surgery and Neurosurgery, Perelman School of Medicine Clinical Associate, School of Nursing, University of Pennsylvania, Philadelphia, USA

    Jose L. Pascual

  • Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

    Timothy G. Gaulton

About the editors

Jose L. Pascual, MD, PhD, FRCS(C), FACS, FCCM
Associate Professor of Surgery and Neurosurgery
Perelman School of Medicine
Clinical Associate, School of Nursing
University of Pennsylvania
Philadelphia, PA, 1904
USA

Timothy G. Gaulton, MD, MSc
Assistant Professor of Anesthesiology and Critical Care
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA, 1904 
USA


Jose Pascual is an intensivist/surgeon at the University of Pennsylvania, board certified in the US and Canada. He finished his fellowship in 2007 and his basic science PhD in resuscitation immunobiology, at McGill University, in 2005. His thesis investigated the salutary effects of immunemodulating fluids in shock.


As faculty of Medical and Nursing Schools, Dr. Pascual teaches students, residents, fellows and advance practice providers in several didactic and skills courses. However, most notable is his role as research mentor for medical, nursing and undergraduate students raising questions at the bedside and attempting to answer them through clinical or basic science research projects. In the last 5 years, Dr. Pascual has mentored 23 research trainees, several of whom have won awards at national/international scientific meetings.


Jose Pascual’s research interests include Traumatic Brain Injury, shock and ICU education through simulation and patient safety initiatives. His TBI laboratory studies immune responses to injury through intravital microscopy of the cerebral microcirculation investigating the role of the neutrophil in injury and shock. 


Dr. Pascual has launched several ICU educational initiatives using simulation integrated within the ICU to teach day-to-day emergent event management by the multidisciplinary team (NPs, MDs, nurses, pharmacists) through learning from errors or near misses. Initiatives relating to videorecorded simulator-generated or real emergent events have been integrated in ICU Quality Improvement efforts and also published.


Timothy Gaulton is an board certified intensivist/anesthesiologist at the University of Pennsylvania.  He completed residency in anesthesiology at Brigham and Women’s Hospital in 2016 and fellowship in critical care medicine at the University of Pennsylvania in 2018.  Dr. Gaulton works clinically in neurologic/neurosurgical and trauma ICUs.  Dr. Gaulton’s academic focus is on perioperative outcomes research and optimizing functional and cognitive recovery after acute illness and trauma, particularly in older adults and the obese.

Bibliographic Information

  • Book Title: Opioid Use in Critical Care

  • Book Subtitle: A Practical Guide

  • Editors: Jose L. Pascual, Timothy G. Gaulton

  • DOI: https://doi.org/10.1007/978-3-030-77399-1

  • Publisher: Springer Cham

  • eBook Packages: Medicine, Medicine (R0)

  • Copyright Information: Springer Nature Switzerland AG 2021

  • Hardcover ISBN: 978-3-030-77398-4Published: 22 July 2021

  • Softcover ISBN: 978-3-030-77401-1Published: 23 July 2022

  • eBook ISBN: 978-3-030-77399-1Published: 21 July 2021

  • Edition Number: 1

  • Number of Pages: X, 287

  • Number of Illustrations: 6 b/w illustrations, 16 illustrations in colour

  • Topics: Intensive / Critical Care Medicine, Pain Medicine

Buy it now

Buying options

eBook USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Other ways to access