Official websites use. Share sensitive information only on official, secure websites. Depth of sedation has evolved over the last 40 years no-sedation, deep sedation, daily emergence, minimal sedation, etc. Most guidelines now recommend determining the depth of sedation and minimizing the use of benzodiazepines and opioids.
Since no general guidelines exist for the use of alpha-2 agonists for CCU sedation, our clinical experience is summarized for the benefit of physicians in clinical situations in which a recommendation might never exist refractory delirium tremens; unstable, hypovolemic, hypotensive patients, etc.
Because the physiology of alpha-2 receptors and the pharmacology of alpha-2 agonists lead to personalized indications, some details are offered. Since interactions between conventional sedatives and alpha-2 agonists have received little attention, these interactions are addressed. Within the existing guidelines for CCU sedation, this article could facilitate the use of alpha-2 agonists as effective and safe sedation while awaiting large, multicentre trials and more evidence-based medicine.
Keywords: Critical care, sedation, general anaesthesia, conventional sedation, cooperative sedation, alpha-2 adrenergic agonists, alpha-2 agonists, clonidine, dexmedetomidine, guanfacine. The use of deep sedation, that is, de facto [ 1 ] general anaesthesia, in the critical care unit CCU generated concerns.
Indeed, high plasma concentrations of benzodiazepines and opioids are associated with CCU delirium. The German guidelines[ 4 ] distinguish sedation strategies for pregnant and breastfeeding women; end-of-life patients; patients with severe burns, multiple trauma, or intracranial hypertension; post-cardiac surgery patients; and patients on extracorporeal membrane oxygenation ECMO or in the prone position.
