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4. Clinical Practice: Should we Radically Alter our Sedation of Critical Care Patients, Especially Given the COVID-19 Pandemics?

Author

Longrois, D, Petitjeans, F, Simonet, O, de Kock, M, Belliveau, M, Pichot, C, Lieutaud, Th, Ghignone, M, and Quintin, L

Subjects
Original Paper, Critical care, alpha-2 agonists, sedation, alpha-2 adrenergic agonists, dexmedetomidine, general anaesthesia, conventional sedation, cooperative sedation, clonidine, guanfacine
Abstract

The high number of patients infected with the SARS-CoV-2 virus requiring care for ARDS puts sedation in the critical care unit (CCU) to the edge. 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. The broader use of alpha-2 adrenergic agonists (‘alpha-2 agonists’) led to sedation regimens beginning at admission to the CCU that contrast with hypnotics+opioids (“conventional“ sedation), with major consequences for cognition, ventilation and circulatory performance. The same doses of alpha-2 agonists used for ‘cooperative’ sedation (ataraxia, analgognosia) elicit no respiratory depression but modify the autonomic nervous system (cardiac parasympathetic activation, attenuation of excessive cardiac and vasomotor sympathetic activity). Alpha-2 agonists should be selected only in patients who benefit from their effects (‘personalized’ indications, as opposed to a ‘one size fits all’ approach). Then, titration to effect is required, especially in the setting of systemic hypotension and/or hypovolemia. 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.

Published
2021

12. Clinical Practice: Should we radically alter our sedation of critical care patients, Especially given the COVID-19 pandemics?

Author

Longrois, D, Petitjeans, F, Simonet, O, Kock, M de, Belliveau, M, Pichot, C, Lieutaud, Th, Ghignone, M, and Quintin, L

Abstract

The high number of patients infected with the SARS-CoV-2 virus requiring care for ARDS puts sedation in the critical care unit (CCU) to the edge. 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. The broader use of alpha-2 adrenergic agonists (‘alpha-2 agonists’) led to sedation regimens beginning at admission to the CCU that contrast with hypnotics+opioids (“conventional“ sedation), with major consequences for cognition, ventilation and circulatory performance. The same doses of alpha-2 agonists used for ‘cooperative’ sedation (ataraxia, analgognosia) elicit no respiratory depression but modify the autonomic nervous system (cardiac parasympathetic activation, attenuation of excessive cardiac and vasomotor sympathetic activity). Alpha-2 agonists should be selected only in patients who benefit from their effects (‘personalized’ indications, as opposed to a ‘one size fits all’ approach). Then, titration to effect is required, especially in the setting of systemic hypotension and/or hypovolemia. 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.

Published
2020
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13. Pressor Response to Noradrenaline in the Setting of Septic Shock: Anything New under the Sun—Dexmedetomidine, Clonidine? A Minireview

Author

Géloën, A., Pichot, C., Leroy, S., Julien, C., Ghignone, M., May, C. N., and Quintin, L.

Subjects
Article Subject
Abstract

Progress over the last 50 years has led to a decline in mortality from ≈70% to ≈20% in the best series of patients with septic shock. Nevertheless, refractory septic shock still carries a mortality close to 100%. In the best series, the mortality appears related to multiple organ failure linked to comorbidities and/or an intense inflammatory response: shortening the period that the subject is exposed to circulatory instability may further lower mortality. Treatment aims at reestablishing circulation within a “central” compartment (i.e., brain, heart, and lung) but fails to reestablish a disorganized microcirculation or an adequate response to noradrenaline, the most widely used vasopressor. Indeed, steroids, nitric oxide synthase inhibitors, or donors have not achieved overwhelming acceptance in the setting of septic shock. Counterintuitively, α2-adrenoceptor agonists were shown to reduce noradrenaline requirements in two cases of human septic shock. This has been replicated in rat and sheep models of sepsis. In addition, some data show that α2-adrenoceptor agonists lead to an improvement in the microcirculation. Evidence-based documentation of the effects of alpha-2 agonists is needed in the setting of human septic shock.

Published
2015
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14. Do we feel pain during anesthesia? A critical review on surgery-evoked circulatory changes and pain perception

Author

Cividjian, A., Petitjeans, F., Liu, N., Ghignone, M., de Kock, M., and Quintin, L.

Abstract

The difficulty of defining the three so-called components of « an-esthesia » is emphasized: hypnosis, absence of movement, and adequacy of anti-nociception (intraoperative « analgesia »). Data obtained from anesthetized animals or humans delineate the activation of cardiac and vasomotor sympathetic reflex (somato-sympathetic reflex) and the cardiac parasympathetic deactivation observed following somatic stimuli. Sympathetic activation and parasympathetic deactivation are used as monitors to address the adequacy of intraoperative anti-nociception. Finally, intraoperative nociception through the administration of nonopioid analgesics vs. opioid analgesics is considered to achieve minimal postoperative side effects.

Published
2024
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15. Abstracts

Author

Nicholas, J. F., Fuller, J., Frewen, T. C., Lee, R., Broadman, L. M., Soliman, I. E., Hannallah, R. S., McGill, W. A., Tsuneto, S., Yamashita, M., Miyamoto, Y., Badgwell, J. M., McLeod, M. E., Lerman, J., Creighton, R. E., O’Toole, D., McCarroll, S. M., Peyton, M., Cunningham, AJ., Ramsay, J. G., Rajagopalan, B., Harmsen, E., Bore, P., Foëx, P., Radda, G., Blaise, G. A., Lenis, S. G., Sill, C., Vanhoutte, P., Irish, C. L., Murkin, J. M., Guiraudon, G. M, Martineau, R. J., Nadeau, S. G., Montgomery, C. J., Steward, D. J., Chung, D. C., Lam, A. M., Grace, D. M., Gordon, K., Thompson, T., Donati, F., Lahoud, J., Laycock, J. R. D., Bevan, D. R., O’Connor, J. P., Ralley, RE., Katz, J. M., Sami, M. H., Wynands, J. E., Smith, CE., Bevan, D. R., Baxter, M. K., Bevan, J. C., Sangwan, S., Tang, C., Gelb, A. W., Boisvert, D. P., Marchak, E., Lunt, A., Dowman, R., Cowie, N., Kozody, R., McKay, W. P. S., Noble, W. H., Taylor, W. J., Champion, M. C., Barry, A. W., Hurtig, IB., Beland, A., Hollmann, C., Meloche, R., Ringaert, K. R. A., Mutch, W. A. C., Vaghadia, H., Schechter, M. T., Sheps, S. B., Jenkins, L. C., Allen, G. C., Cattran, C. B., Peterson, R. G., Ali, M. J., Byrick, R. J., Salerno, T. A., Baker, C. B., Lichtenstein, S. V., Sharpe, M. J., Merchant, R., Alyafi, W., Penning, D. H., Jhamandas, K., Weingarten, M., Strum, D. P., Eger II, E. I., Gallagher, T. M., Volgyesi, G. A., Miyasaka, K., Burrows, F. A., Johnson, B. H., Murphy, M. R., Szlam, F., Hug, C. C., Martin, D. C., Johnston, J. F., Levin, K. R., Silverstein, P. I., Pruett, J., Bissonnette, B., Scott, A. A., Halpem, S., Rosag, O., Swartz, J., Meeke, R. I., Knill, R. L., Rose, E. A., Soderman, R. M., Milne, B., Cervenko, F., Loomis, C., Murphy, P., Sandler, A. N., Vosu, H., Lau, L. C., Branson, R., Kearney, R. A., Rosales, J. K., Howes, W. J., Wolf, A. R., Fear, D. W., Roy, W. L., Goresky, G. V., Sharpe, T. D. E., Sabourin, MA., Polomeno, R. C., Ryan, B., Evelyn, R., Higgins, T. T., Hannal, R. S., DeSoto, M. H., Nason, S. S., Penning, J. P., Loomis, C. W., Douglas, M. J., McMorland, G. H., Gowan, J. D., Hurtig, J. B., Fraser, R. A., Whalley, D. G., Labrecque, P., Quance, D., Moote, C. A., Lok, P Y. K., Skinner, M. I., Lok, P. Y. K., Scott, W. A. C., Sielecka, D., Slinger, P. D., Lavelle, P. A., Chung, F., McDonald, N. J., McDonald, S., Maltby, J. R., Hutchinson, A., Reid, C. R. G., Whitaker, P. R., Hcin, H. A. T., Arellano, R. J., Cruise, C. J., Lokoff, P., Code, WE., Strunin, L., Manninen, P. H., Macnab, M. S. P., Lam, A., Houston, P. L., tavelle, P., Burns, R., Hall, R. I., Angert, K. C., Reeder, D. A., Moldenhauer, C. C., Teasdale, S., Ralley, F. E., Moffitt, E. A., O’Brien, D. J., Imrie, D. D., Barker, R. A., Sullivan, J. A., Kinley, CE., Block, G., Butlin, G., Sibbald, W., Cunningham, D., Sidi, A., Rush, W. R., Davis, R. F., Bergstrom, R. G., Thomson, I. R., Rosenbloom, M., Meatherall, R. C., Mensink, F. J., Maclntyre, C., Wade, J. G., Ghignone, M., Flynn, N., Cunningham, A. J., Hamilton, R. C., Beauregard, L., Martin, R., Tetrault, J. P., Johnstone, G. K., Clark, A. J. M., Houlton, P. G., Purkis, I. E., Shukla, R. C., Carmichael, F. J., Saldivia, V., Orrego, H., Moote, CA., Smith, M., Drake, H. F., Treasure, T., Olson, J., Strauss, R., Zetterstrom, H., Jonsson, L. O., Forbes, R. B., Albanese, M. A., Murray, D. J., Barcellos, W. A., Slinger, P., Triolet, W., Wilson, J., Berger, J. J., Gravenstein, J. S., McLaughlin, G., Boysen, P. G., Wolf, G. L., Simpson, J. I., Humphrey, D., and Brock-Utne, J. G.

Published
1987
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16. Abstracts of scientific papers computers in anesthesia VI

Author

Dettinger, W., Munshi, C. A., Hart, H. B., Edmonds, H. L., Reiss, S. J., Humble, R. S., Edmonds, H. L., Buck, J. S., Tsueda, K., Rigor, B. M., Huang, K. C., Feldman, J. M., Pugh, G., Gravenstein, J. S., van der Aa, J., Paulus, D. A., van der Aa, J. J., McLanghlin, G. A, Culberson, M. K., Radson, E. A., Gravenstein, J. S., Eames, J. S., Littlefield, J., Pugh, G. L., Gravensiein, J. S., Ghignone, M., Sridaromont, S., Calvillo, O., Lousteau, J., Grogono, A. W., Lowe, H. J., Lowe, J. A., Minthorn, L. M., Wachtel, R. E., Moberg, R. S., Young, W. L., Montejo, L. S., Skaredoff, M. N., Myers, R. W., Maneksha, F. R., Sidhu, U., Poppers, P. J., Tanner, G. E., Angers, D. G., and VanEss, D. M.

Published
1985
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17. Abstracts

Author

Kieraszewicz, H. T., Lam, A. M., Steward, D. J., Volgyesi, G. A., Smedstead, K. G., Powles, A. C. P., Wolf, G. L., Capuano, C., Chartrand, D., Couture, J., Cole, C. P., Donatī, F., Maillé, J. G., Roof, A., Blain, R., Finley, G. A., Cherry, M., Cotton, D., Nicholas, J. F., Petkau, D., Kettner, J. D., Ramsay, J. G., Townsend, G. E., Martin, R., Tétrault, J. P., Tétreault, L., Lamarche, Y., Veilleux, L. J., Gotta, A. W., Carsons, S., Abrams, L., Sullivan, C., Futter, M. E., Whalley, D. R., Wynands, J. E., Bevan, D. R., Ghignone, M., Prewitt, R. M., Razen, M., Girling, L., Slykerman, L., Kay, J. C., Noble, W. H., Forrest, J. B., Chambers, C., Kozody, R., Cheney, F., Chambers, C., Carli, F., Higgs, B. D., Knill, R. L., Thompson, W. R., Clement, J. L., Varkey, G. P., Spoerel, W. E., Moffat, J. A., McDougall, M., Spence, D., Saunders, F., Shelley, E. S., Cervenko, F. W., Brunet, D., Milne, B., Harris, P. W., Morison, D. H., Dunn, G. L., Fargas-Babjak, A. M., Moudgil, G. C., Smedsted, K., Woo, J., Williams, J. G., Strunin, L., Ward, S., Wright, D., Corall, I., Neill, E. A. M., Marty, J., De Champlain, J., Kenefick, J. P., Roth, S., Jhamandas, K., Hemmings, C. T., Weeks, S. K., Smith, J. B., Ong, B. Y., Tweed, W. A., Yarnell, R., Sitar, D. S., McLeod, M. E., Roy, L., and Bennett, K. J.

Published
1983
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24. Clonidine for Major Vascular Surgery in Hypertensive Patients

Author

QUINTIN, L., primary, BOUILLOC, X., additional, BUTIN, E., additional, BAYON, M. C., additional, BRUDON, J. R., additional, LEVRON, J. C., additional, TASSEN, H., additional, BOUCAUD, C., additional, TISSOT, S., additional, FREHRING, B., additional, PETIT, P., additional, DANAYS, T., additional, VIALE, J. P., additional, and GHIGNONE, M., additional

Published
1997
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25. Clonidine for Major Vascular Surgery in Hypertensive Patients

Author

Quintin, L., primary, Bouilloc, X., additional, Butin, E., additional, Bayon, M. C., additional, Brudon, J. R., additional, Levron, J. C., additional, Tassan, H., additional, Boucaud, C., additional, Tissot, S., additional, Frehring, B., additional, Petit, P., additional, Danays, T., additional, Viale, J. P., additional, and Ghignone, M., additional

Published
1996
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33. Haemodynamic effects of clonidine injected epidurally in halothane-anaesthetized dogs.

Author

Ghignone, Marco, Calvillo, Octavio, Quintin, Luc, Caple, Samuel, Kozody, Raymond, Ghignone, M, Calvillo, O, Quintin, L, Caple, S, and Kozody, R

Abstract

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
1987
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36. AORTIC SURGERY

Author

Ouintin, L., primary, Macquin, I., additional, Bonnet, F., additional, Szekely, B., additional, and Ghignone, M., additional

Published
1988
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