Abstract
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 μg kg−1 min−1 (1.44 mg 70 kg−1 24h−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 μg 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.
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References
Bloor BC, Flacke JW, Flacke WE (1986) Perioperative clonidine withdrawal syndrome. In: Reves JG (ed) Common problems in cardiac anesthesia. Year Book Medical Publ, Chicago, pp 397–405
Flacke JW, Bloor BC, Flacke WE, Wong, D, Dazza S, Stead SW, Laks H (1987) Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology 67:11–19
Ghignone M, Calvillo O, Quintin L (1987) Anesthesia and hypertension: the effect of clonidine on perioperative hemodynamics and isoflurane requirements. Anesthesiology 67:3–10
Gold MS, Redmond DE, Kleber HD (1978) Clonidine blocks acute opiate-withdrawal symptoms. Lancet II:599–602
Pohl S, Heidenreich W, Plein S, Knitsch W (1989) Entzugsbehandlung mit Clonidin während der Schwangerschaft. Anaesthesist 38:498–500
Cushman P (1987) Clonidine and alcohol withdrawal. Adv Alcohol Subst Abuse 7:17–28
Metz G, Nebel B (1983) Clonidin beim schweren Alkohol-Entzugsdelir. Fortschr Med 101:1260–1264
Wing LMH, Reid JL, Hamilton CA, Sever P, Davies DS, Dollery CT (1977) Effects of clonidine on biochemical indices of sympathetic function and plasma renin activity in normotensive man. Clin Sci 53:45–53
Hermiller JB, Magorien RD, Leithe ME, Unverferth DV, Leier CV (1983) Clonidine in congestive heart failure: a vasodilator with negative inotropic effects. Am J Cardiol 51:791–795
Giles TD, Iteld BJ, Mautner RK, Rognoni PA, Dillenkoffer RL (1981) Short-term effects of intravenous clonidine in congestive heart failure. Clin Pharmacol Ther 30:724–728
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Böhrer, H., Bach, A., Layer, M. et al. Clonidine as a sedative adjunct in intensive care. Intensive Care Med 16, 265–266 (1990). https://doi.org/10.1007/BF01705163
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DOI: https://doi.org/10.1007/BF01705163