Respiratory depression under long-term sedation with sufentanil, midazolam and clonidine has no clinical significance

Prause, A.; Wappler, Frank; Scholz, Jens; Bause, Hanswerner; Esch, Jochen Schulte am

doi:10.1007/s001340000637

Cited by 27 publications

(11 citation statements)

References 11 publications

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“…Moreover, its context-sensitive half-life (i.e., the time required to obtain a 50% reduction in the plasma drug concentration after the end of the infusion) is sevenfold lower that of fentanyl with, consequently, a reduced risk of accumulation. 4,12,13 Our data confirm and expand the finding of Prause et al, 6 who retrospectively evaluated the charts of 211 critically ill patients receiving a continuous infusion of sufentanil at different doses (range 0.075-1.22 µg·kg -1 ·hr -1 ) to obtain a modified Ramsay sedation score between 2 and 4 during various partial respiratory support modes (continuous positive airway pressure, synchronized intermittent mandatory ventilation or PSV). These authors observed only a modest increase of PaCO 2 from 39.5 ± 7.3 mmHg (before initiating sedation) to 42.7 ± 6.8 mmHg during the continuous infusion of sufentanil.…”

Section: Figure Effects Of Sufentanil On Respirtory Variablessupporting

confidence: 83%

“…Unfortunately few data are available regarding the respiratory effects of analgesia-sedation with sufentanil in patients during partial ventilatory support modes. 6 We conducted a prospective physiologic pilot study aimed at evaluating the effects of the continuous infusion of a single sedative, sufentanil, at 0.2 to 0.3 µg·kg -1 ·hr -1 on central respiratory drive, gas exchanges, respiratory pattern and inspiratory impedance of the respiratory system in a group of 12 patients during pressure support ventilation (PSV). P Pa at ti ie en nt ts s a an nd d m me et th ho od ds s Twelve consecutive patients, endotracheally intubated and mechanically ventilated, were enrolled from August to November 2000 in the 21-bed general ICU located in our University Hospital in Rome.…”

Section: Objectifmentioning

confidence: 99%

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Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respiration: a pilot study

Conti

Arcangeli

Antonelli

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To evaluate the effects of sedation with sufentanil on respiratory drive, respiratory pattern, and gas exchange of critically ill patients during pressure support ventilation. M Me et th ho od ds s: :In this prospective observational cohort study, we observed 12 adult patients receiving partial ventilatory support for acute respiratory failure. Each subject received a continuous infusion of sufentanil at 0.2 to 0.3 µg·kg to obtain a modified Ramsay sedation score between 2 and 3. In basal conditions and at variable distance from the beginning of the sufentanil infusion (10', 30', 60', 120', 24 hr) we evaluated gas exchange, hemodynamic variables, respiratory rate (RR), tidal volume (TV), respiratory pattern, respiratory drive (P0.1) and inspiratory impedance of the respiratory system [P0.1/TV/inspiratory time (Ti)]. of sufentanil resulted in the desired level of sedation. No significant heart rate, heart rhythm and blood pressure changes were observed. Sufentanil infusion did not affect TV, minute volume, Ti/inspiratory duty cycle, RR, P0.1, P0.1/TV/Ti and gas exchange did not change significantly over the study period.C Co on nc cl lu us si io on n: : A continuous infusion of sufentanil induces "awake" sedation with no detectable effects on respiratory variables in critically ill patients during partial ventilatory support. EDATION and analgesia are widely used in intensive care unit (ICU) patients, particularly during mechanical ventilation.Critically ill patients often experience stressful maneuvers such as endotracheal intubation and mechanical ventilation, suctioning or painful diagnostic and therapeutic interventions. The net effect is an increase in catecholamine secretion and oxygen demand with further systemic and coronary vasoconstriction.1 An adequate level of analgesia and sedation (analgesia-sedation) is thus a precious tool to control

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Section: Figure Effects Of Sufentanil On Respirtory Variablessupporting

confidence: 83%

Section: Objectifmentioning

confidence: 99%

Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respiration: a pilot study

Conti

Arcangeli

Antonelli

et al. 2004

Can J Anesth/J Can Anesth

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“…Wappler and coworkers [22] found that continuous infusion of sufentanil (1 μg/kg per hour was given initially) for analgesia and sedation is suitable for intensive care patients with a short stay in the ICU. Prause and colleagues [10] found that critically ill patients under continuous sedation with sufentanil (median 0.44 μg/kg per hour) exhibit a statistically significant rise in arterial carbon dioxide tension, but this respiratory depression is only slight and has no clinical significance. Mechanically assisted spontaneous ventilation modes can safely be used under continuous sedation with sufentanil.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, its short duration of action means that the desired analgesic effect will continue for as long as the infusion is continued, and any undesirable side effects will be short-lived following discontinuation [9]. In addition, mechanically assisted spontaneous ventilation modes can safely be used under continuous sedation with sufentanil [10]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of sufentanil with sufentanil plus magnesium sulphate for sedation in the intensive care unit using bispectral index

et al. 2003

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Correspondence: Dilek Memis ², dilmemis@mynet.com R123 APACHE = Acute Physiology and Chronic Health Evaluation; BIS = bispectral index; ICU = intensive care unit. AbstractIntroduction In intensive care unit patients we assessed, using bispectral index (BIS) monitoring, whether the addition of magnesium sulphate infusion could decrease the sufentanil infusion required to maintain sedation. Patients and methods A total of 30 adult patients who were expected to require machanical ventilation for 6 hours in the intensive care unit were randomly assigned to receive either sufentanil infusion or sufentanil plus magnesium infusion. We monitored BIS levels continously. BIS levels in the range 61-88 are required to maintain a state of sedation, and in both groups BIS levels were kept within this range by increasing or decreasing the sufentanil infusion. Hourly consumption of sufentanil was monitored. Cardiovascular, respiratory and biochemical data were recorded. Results There was no significant difference between the groups with respect to cardiovascular, respiratory and biochemical parameters. Magnesium infusion, when added to sufentanil infusion, decreased the consumption of sufentanil at all times accept during the first hour (P < 0.001). There was no significant difference in BIS values between the groups (P > 0.05). Conclusion This is the first clinical study to demonstrate that magnesium sulphate infusion decreases sufentanil requirements. Because of the limited number of patients included and the short period of observation, our findings must be confirmed by larger clinical trials of magnesium infusion titrated to achieve prespecified levels of sedation. Furthermore, randomized clinical studies are needed to determine the effects of magnesium infusion on opioids.

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“…Sufentanil ist ebenfalls ein synthetischer Rezeptoragonist mit hoher Selektivität für den µ  -Rezeptor. Daraus ergibt sich ein für die Analgosedierung günstiges Wirkspektrum mit einer potenten Analgesie und einer im Vergleich zu anderen Opioiden 7geringeren Atemdepression [77]. Eine pathophysiologisch sinnvolle Spontanatmung ist somit leichter zu realisieren.…”

Section: Analgesieunclassified

Analgesie und Sedierung in der Intensivmedizin

Schaffrath¹,

Kuhlen

Tonner

2004

Anaesthesist

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Sedation and analgesia are relevant aspects for the adequate treatment of patients in an intensive care unit. Recent drug developments and new strategies for ventilation provide improved sedation management allowing better adaptation to the clinical background and individual needs of the patient. This article provides an overview on the application of different substance groups. Focus is placed on newly developed pharmaceuticals such as dexmedetomidine. Another aspect is scoring system-related and EEG-based monitoring of depth of sedation. Modern concepts of analgesia and sedation for ICU patients have been developed based on the interaction of different parameters such as adaptive sedation and analgesia management (ASAM).

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Respiratory depression under long-term sedation with sufentanil, midazolam and clonidine has no clinical significance

Cited by 27 publications

References 11 publications

Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respiration: a pilot study

Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respiration: a pilot study

Comparison of sufentanil with sufentanil plus magnesium sulphate for sedation in the intensive care unit using bispectral index

Analgesie und Sedierung in der Intensivmedizin

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