Clonidine as a sedative adjunct in intensive care.
A 63-year-old man underwent distal oesophagectomy and proximal gastrectomy. Postoperatively, controlled ventilation was necessary for 53 days because of anastomotic leakage. Multiple sedative regimens proved to be inadequate. By contrast, a fentanyl-midazolam combination with continuous supplementation of clonidine 0.014 micrograms kg-1 min-1 (1.44 mg 70 kg-1 24 h-1) was very effective in terms of sedation and pain relief. During combined fentanyl-midazolam and clonidine infusion, cardiovascular depression gradually developed over several days necessitating the institution of a dobutamine infusion (dose: 8-12 micrograms kg-1 min-1). Four attempts of abrupt clonidine withdrawal were followed by sympathetic overshoot reactions consisting of tachycardia, hypertension, agitation, and sweating. Discontinuation of clonidine was finally possible after a 12-day weaning period.
Böhrer
H
H
Department of Anaesthesia, University of Heidelberg, FRG.
Bach
A
A
Layer
M
M
Werning
P
P
D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003422:Critical Care; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D005743:Gastrectomy; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011182:Postoperative Care; D012121:Respiration, Artificial; D013375:Substance Withdrawal Syndrome
D003000:Clonidine; D008874:Midazolam; D005283:Fentanyl