title: [A protocol for the cessation of sedation in brain-injured patients].
abstract: OBJECTIVE
  The cessation of sedation in brain-injured patients may result in severe agitation and/or acute withdrawal syndrome related to the prolonged administration of large doses of benzodiazepines and/or opioids. The aim of the present study was to assess the clinical efficacy of a written protocol to withdraw sedation for these patients.
  
  
  METHODS
  Observational prospective study.
  
  
  METHODS
  After approval by the Institutional Review Board, 40 severely brain-injured patients were included. They had received continuous administration of midazolam and sufentanil or fentanyl for median 15 days. On cessation of midazolam infusion, patients were given clorazepate for 3 days. On cessation of opioid infusion and clorazepate, clinical data were collected for 48 hours: heart rate, systolic blood pressure, respiratory rate, agitation, and pupil diameter. If an opioid withdrawal syndrome occurred, patients received a 48-hour continuous infusion of buprenorphine.
  
  
  RESULTS
  Of 40 patients, there were 10 who did not require buprenorphine. An agitation occurred 5 hours (1-21) after cessation of opioid, associated with tachycardia, arterial hypertension, and tachypnea. After 6 hours buprenorphine treatment, these parameters were normalized. No patient needed the reintroduction of the initial sedation.
  
  
  CONCLUSIONS
  The cessation of sedation in severely brain-injured patients can be successfully managed with the use of clorazepate, associated with buprenorphine in the presence of agitation.
authors.affiliation: Pôle d'anesthésie-réanimation, hôpital Michallon, BP 217, 38043 Grenoble cedex 09, France.
authors.forename: I
authors.initials: I
authors.lastname: Reynaud-Davin
authors.forename: G
authors.initials: G
authors.lastname: Francony
authors.forename: B
authors.initials: B
authors.lastname: Fauvage
authors.forename: C
authors.initials: C
authors.lastname: Canet
authors.forename: F
authors.initials: F
authors.lastname: Coppo
authors.forename: J-F
authors.initials: JF
authors.lastname: Payen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000209:etiology* / Q000517:prevention & control*; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives