A case of difficult sedation in ICU

R. Pop, M. Bemer, V.Robert, C.Streff
CHR Metz-Thionville, Réanimation Polyvalente Hôpital Bel Air, Thionville, Franţa

Abstract

The case of a patient is presented who developed an unusual resistance to sedation with midazolam, using standard protocol. The midazolam resistance was documented clinically and by measurement of the midazolam concentration in blood. As the registered concentration of midazolam was high enough to ensure an adequate sedation which, however, was not achieved, another protocol of sedation, using clonidine and sufentanil was applied with good results. The lack of sedation after midazolam was explained by possible genetic alteration of the receptor GABA-A. The favorable effect of clonodine is the consequence of action on different kind of receptors (alpha 2 adrenergic).

Key words: mechanical ventilation, difficult sedation, midazolam, clonidine.

CAZ CLINIC

Un caz de sedare dificilă în reanimare

Jurnalul Român de Anestezie Terapie intensivă 2005 Vol.12 Nr.2, 153-156