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The addition of haloperidol, propofol, or midazolam to sufentanil for intravenous sedation in the intensive care unit using bispectral index

Baris Tukenmez, MD, Dilek Memis, MD, Zafer Pamukcu, MD


Aim: Inadequate sedative techniques may adversely affect morbidity and mortality in the intensive care unit (ICU), and the search for the ideal sedative agent continues. Combinations of hypnotics and opiates have are commonly used for sedation. In this study, the authors aimed to assess whether or not the addition of a haloperidol, propofol, or midazolam infusion decreased the sufentanil requirements by using bispectral index (BIS).
Material and Methods: The study involved 60 patients in the ICU. All patients received 0.5 μg/kg sufentanil IV bolus. Immediately after, group S received 0.25 μg/kg sufentanil infusion, group SH received sufentanil infusion + haloperidol 3 mg/h infusion, group SP received sufentanil infusion + propofol 25 μg/kg/min infusion, and group SM received sufentanil infusion + midazolam 0.04 mg/kg/h infusion, for 6 hours. Average BIS values 61-80 and Ramsay Sedation Score 2-5 were kept at a range of by decreasing or increasing sufentanil levels in all groups and hourly sufentanil consumption was determined. Hemodynamic and biochemical parameters and arterial blood gases were determined at baseline and were repeated in study hours.
Results: There was no significant difference in hemodynamic and biochemical parameters and arterial blood gases among the groups. Propofol, midazolam, haloperidol infusion, when added to sufentanil infusion, decreased the consumption of sufentanil in all the measured times (p < 0.001).
Conclusions: The authors aimed to determine the effects of haloperidol, propofol, or midazolam infusion when added to sufentanil infusion in a short period of time. The authors found that propofol, midazolam, and haloperidol infusion decreased the sufentanil requirements in ICU patients.


sedation, sufentanil, haloperidol, propofol, midazolam, bispectral index, intensive care unit

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Venn RM, Grounds RM: Comparison between dexmedetomidine and propofol for sedation in the intensive care unit. Br J Anaesth. 2001; 87: 684-690.

Riess ML, Graefe UA, Goeters C, et al.: Sedation assessment in critically ill patients with bispectral index. Eur J Anaesthesiol. 2002; 19: 18-22.

Burns AM, Shelly MP, Park GRİ: The use of sedative agents in critically ill patients. Drugs. 1992; 43: 507-515.

Liu J, Singh H, White PF: Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. Anesthesiology. 1996; 84: 64-69.

Glass PS, Bloom M, Kearse L, et al.: Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997; 86: 836-847.

Freye E, Neruda B, Falke K: EEG-Powerspektren und evozierte Potentiale unter Alfentanil/midazolam-Analgosederung bei Intensivpatienten. Anasthesiol Intensivmed Notfallmed Schmerzther. 1991; 26: 384-388.

Campbell ML, Bizek KS, Thill M: Patient responses during rapid terminal weaning from mechanical ventilation: A prospective study. Crit Care Med. 1999; 27: 73-77.

Flacke JW, Bloor BC, Kripke W, et al.: Comparison of morphine, meperidine, fentanyl, and sufentanil in balanced anesthesia: A double-blind study. Anesth Analg. 1985; 64: 897-910.

Palmer CM: Continuous intrathecal sufentanil for postoperative analgesia. Anesth Analg. 2001; 92: 244-245.

Prause A, Wappler F, Scholz J, et al.: Respiratory depression under long-term sedation with sufentanil, midazolam and clonidine has no clinical significance. Intensive Care Med. 2000; 26: 1454-1461.

Weinbroum AA, Halpern P, Rudick V, et al.: Midazolam versus propofol for long-term sedation in the ICU: A randomized prospective comparison. Intensive Care Med. 1997; 23: 1258-1263.

Riker RR, Fraser GL, Cox PM: Continuous infusion of haloperidol controls agitation in critically ill patients. Crit Care Med. 1994; 22: 433-440.

Seneff MG, Mathews RA: Use of haloperidol infusions to control delirium in critically ill adults. Ann Pharmacother. 1995; 29: 690-693.

Knaus WA, Draper EA, Wagner DP, et al.: APACHE II: A severity of disease classification system. Crit Care Med. 1985; 13: 818-829.

Hansen-Flaschen J, Cowen J, Polomano RC: Beyond the Ramsay scale: Need for a validated measure of sedation drug efficacy in the intensive care unit. Crit Care Med. 1994; 22: 732-733.

Sigl JC, Chamoun NC: An introduction to bispectral analysis for the EEG. J Clin Monit. 1994; 10: 392-404.

Shapiro BA: Bispectral index: Better information for sedation in the intensive care unit? Crit Care Med. 1999; 27: 1663-1664.

Riess ML, Graefe UA, Goeters C, et al.: Sedation assessment in critically ill patients with bispectral index. Eur J Anaesthesiol. 2002; 19: 18-22.

Berkenbosch JW, Fichter CR, Tobias JD: The correlation of the bispectral index monitor with clinical sedation scores during mechanical ventilation in the pediatric intensive care unit. Anesth Analg. 2002; 94: 506-511.

Kroll W, List WF: Is sufentanil suitable for long-term sedation of a critically ill patient? Anaesthesist. 1992; 41: 271-275.

Wappler F, Scholz J, Prause A, et al.: Level concept of analgesic dosing in intensive care medicine with sufentanil. Anasthesiol Intensivmed Notfallmed Schmerzther. 1998; 33: 8-26.

Memis D, Turan A, Karamanlioğlu B, et al.: Comparison between sufentanil and sufentanil + magnesium sulphate for sedation in the intensive care unit with bispectral index. Crit Care. 2003; 7: R123-R128.

Monk CR, Coates DP, Prys-Roberts C, et al.: Haemodynamic effects of a prolonged infusion of propofol as a supplement to nitrous oxide anaesthesia. Br J Anaesth. 1987; 59: 954-960.

Brussel T, Theissen JL, Vigfusson G, et al.: Haemodynamic and cardiodynamic effects of propofol and etomidate: Negative inotropic properties of propofol. Anesth Analg. 1989; 69: 35-40.

Roekaerts PMHJ, Huygen FJPM, de Lange S: Infusion of propofol versus midazolam for sedation in the intensive care unit following coranary artery surgery. J Cardiothorac Vasc Anesth. 1993; 7: 142-147.

Ilkiv JE, Pascoe PJ, Haskins SC, et al.: Cardiovascular and respiratory effects of propofol administration in hypovolemic dogs. Am J Vet Res. 1992; 53: 2323-2327.

Carrasco G, Molina R, Costa J, et al.: Propofol vs midazolam in short-, medium-, and long-term sedation of critically ill patients. Chest. 1993; 103: 557-564.

Ronan KP, Gallagher TJ, George B, et al.: Comparison of propofol and midazolam for sedation in intensive care units patients. Critical Care Med. 1995; 23: 286-293.

Adams F, Fernandez F, Andersson BS: Emergency pharmacotherapy of delirium in the critically ill cancer patient. Psychosomatics. 1986; 27(suppl): 33-37.

Kanto JH: Propofol, the newest induction agent of anesthesia. Int J Clin Pharmacol Ther Toxicol. 1988; 26: 41-57.

Maltbie AA, Cavenar JO, Sullivan JL, et al.: Analgesia and haloperidol: A hypothesis. J Clin Psychiatry. 1979; 40: 323-326.

Vuyk J: Clinical interpretation of pharmacokinetic and pharmacodynamic propofol-opioid interactions. Acta Anaesth Belg. 2001; 52: 445-451.

Mertens MJ, Olofsen E, Engbers FHM, et al.: Propofol reduces perioperative remifentanil requirements in a synergistic manner. Anesthesiology. 2003; 99: 347-359.

Gamble JAS, Kawar P, Dundee JW, et al.: Evaluation of midazolam as an intravenous induction agent. Anaesthesia. 1981; 36: 868-873.

Stella L, Crescenti A, Torri G: Effect of naloxane on the loss of consciousness induced by i.v. anaesthetic agents in man. Br J Anaesth. 1984; 56: 369-373.

Billingsley LM, Kubena KR: The effects of naloxane and picrotoxin on the sedative and anticonflict effects of benzodiazepines. Life Sci. 1978; 22: 897-906.

Wuster M, Duka T, Herz A: Diazepam-induced release of opioid activity in the rat brain. Neurosci Lett. 1980; 16: 335-337.

Menza MA, Murray GB, Holmes VF, et al.: Decreased extrapyramidal symptoms with intravenous haloperidol. J Clin Psychiatry. 1987; 48: 278-280.

Barach E, Dubin LM, Tomlanovich MC, et al.: Dystonia presenting as upper airway obstruction. J Emerg Med. 1989; 7: 237-240.

Shalev A, Hermesh H, Munitz H: Mortality from neuroleptic malignant syndrome. J Clin Psychiatry. 1989; 50: 18-25.

Seneff MG, Mathews RA. Use of haloperidol infusions to control delirium in critically ill adults. Ann Pharmacother. 1995; 29: 690-693.



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