Évaluation d'un protocole d'arrêt de la sédation chez le patient cérébrolésé

Translated title of the contribution: A protocol for the cessation of sedation in brain-injured patients

I. Reynaud-Davin, G. Francony, B. Fauvage, C. Canet, F. Coppo, J. F. Payen

Research output: Contribution to journalArticle

Abstract

Objectives: 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. Study design: Observational prospective study. Patients and 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. Conclusion: 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.

Translated title of the contributionA protocol for the cessation of sedation in brain-injured patients
Original languageFrench
Pages (from-to)109-113
Number of pages5
JournalAnnales francaises d'anesthesie et de reanimation
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2012

Keywords

  • Agitation
  • Brain injury
  • Intensive care
  • Sedation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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