Clonidine as a sedative adjunct in intensive care

Böhrer, H.; Bach, A.; Layer, M.; Werning, P.

doi:10.1007/bf01705163

Cited by 46 publications

(12 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A reasonable use (with regard to time of ventilation and ICU stay) of this agent during weaning was shown by Walz and colleagues [25]. Bohrer and colleagues showed [26] that with clonidine the requirements for opioids and sedation may be reduced.…”

Section: Discussionmentioning

confidence: 99%

Practice of sedation and analgesia in German intensive care units: results of a national survey

et al. 2005

View full text Add to dashboard Cite

Introduction Sedation and analgesia are provided by using different agents and techniques in different countries. The goal is to achieve early spontaneous breathing and to obtain an awake and cooperative pain-free patient. It was the aim of this study to conduct a survey of the agents and techniques used for analgesia and sedation in intensive care units in Germany. Methods A survey was sent by mail to 261 hospitals in Germany. The anesthesiologists running the intensive care unit were asked to fill in the structured questionnaire about their use of sedation and analgesia. Results A total of 220 (84%) questionnaires were completed and returned. The RAMSAY sedation scale was used in 8% of the hospitals. A written policy was available in 21% of hospitals. For shortterm sedation in most hospitals, propofol was used in combination with sufentanil or fentanyl. For longterm sedation, midazolam/fentanyl was preferred. Clonidine was a common part of up to two-thirds of the regimens. Epidural analgesia was used in up to 68%. Neuromuscular blocking agents were no longer used. Conclusion In contrast to the US 'Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult', our survey showed that in Germany different agents, and frequently neuroaxial techniques, were used.

show abstract

Section: Discussionmentioning

confidence: 99%

Practice of sedation and analgesia in German intensive care units: results of a national survey

et al. 2005

View full text Add to dashboard Cite

show abstract

“…For ICU patients in general, appropriate sedation can avert delirium, which has a highly adverse impact on later prognosis [85][86][87][88][89]. Clonidine has been applied in this setting [90][91][92], but dexmedetomidine is currently the only ␣ 2 -agonist approved for use in the ICU in several countries. Dexmedetomidine is distinguished by the quality of sedation it confers [93]: patients sedated with dexmedetomidine are characteristically easy to rouse but lapse into a tranquil, sleep-like state with no respiratory depression [94] when left undisturbed.…”

Section: Sedationmentioning

confidence: 99%

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

Aantaa

Jalonen

2006

European Journal of Anaesthesiology

View full text Add to dashboard Cite

The centrally acting alpha2-adrenoceptor agonists clonidine and dexmedetomidine have been used with success to provide haemodynamic stability for patients undergoing surgery. Particularly in the case of patients with overt or underlying cardiac disease the actions of alpha2-adrenoceptor agonists, which include maintenance of stable systemic blood pressure and low heart rate and a reduction in overall oxygen consumption, can be expected to reduce the risk of procedure-related cardiac events. This expectation has been corroborated in clinical trials with clonidine, dexmedetomidine and mivazerol and meta-analyses; additional large controlled trials would be instructive in establishing a robust estimate of the scale of the benefit. In addition, alpha2-adrenoceptor agonists used as premedication have been shown to substantially reduce anaesthetic requirements among surgical patients, and the use of these agents has been associated with a reduced risk of postoperative delirium, which may be expected to improve considerably the postoperative course for at-risk patients. Dexmedetomidine is the only alpha2-adrenoceptor agonist currently approved for use in the intensive care unit. A distinctive feature of dexmedetomidine in that setting is that in addition to haemodynamic stability it confers a distinctive and advantageous quality of sedation: patients are tranquil but responsive to requests from attending staff. This review examines the pharmacological principles underlying the use of alpha2-adrenoceptor agonists as adjuncts to surgery and clinical experience in that indication.

show abstract

“…Clonidine suppressed opiate 32 and alcohol 25,27 withdrawal. Therefore, its use in the CCU appears logical; clonidine alone (up to 2.5 mg/day) abated withdrawal from sedative agents upon weaning from mechanical ventilation.…”

Section: Sedationmentioning

confidence: 98%

Dexmedetomidine and Clonidine

Pichot¹,

Ghignone

Quintin

2011

J Intensive Care Med

View full text Add to dashboard Cite

In the critical care setting, α-2 agonists present a multifaceted profile: sedation combined with arousability, suppression of delirium, preservation of respiratory drive, reduced O(2) consumption, preserved renal function, and reduced protein metabolism. In addition, this review details the reduced arterial impedance, improved left ventricular performance, preserved vascular reactivity to exogenous amines, preserved cardiac baroreflex reactivity, preserved vasomotor baroreflex activity combined with a lowered pressure set point: these features may explain the good tolerance observed when α-2 agonists are used as continuous infusion without any loading dose. Reviewing the literature allows one to suggest that a new management appears possible with arousable sedation. However, it remains to be demonstrated whether this arousable sedation can be combined with the preservation of spontaneous ventilation, in the setting of severe respiratory distress, as opposed to conventional controlled mechanical ventilation combined with conventional sedation. Should such a speculative view be confirmed, then α-2 agonists will move from second-line sedative agents to first-line sedative agents. However, key studies are lacking to demonstrate the effect of α-2 agonists on physiological endpoints and outcome. Presently, the existing body of data suggests a niche for the use of α-2 agonists in the critical care setting.

show abstract

Clonidine as a sedative adjunct in intensive care

Cited by 46 publications

References 7 publications

Practice of sedation and analgesia in German intensive care units: results of a national survey

Practice of sedation and analgesia in German intensive care units: results of a national survey

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

Dexmedetomidine and Clonidine

Contact Info

Product

Resources

About