DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20182300

Dexmedetomidine versus propofol as a sedative agent in the intensive care unit: a randomized single blinded prospective study

Pollov Borah, Rishav Kakati, Rajib K. Bhattacharyya

Abstract


Background: Sedation is an essential prerequisite for every ICU patient. It promotes patient comfort, helps in alleviation of anxiety, stabilizes vitals and reduces the time to extubation and ICU discharge. This study aims at comparing dexmedetomidine versus propofol in ICU sedation with respect to maintenance of vitals, time to extubation, incidence of adverse effects and cost effectiveness.

Methods: 60 intubated and mechanically ventilated post-surgical ICU patients were randomly allocated to two groups of 30 each. Group D received dexmedetomidine infusion as a loading dose of 0.1mcg/kg/min IV over 10 minutes followed by maintenance infusion of 0.2-0.7mcg/kg/h IV. Group P received propofol infusion as a loading dose of 5mcg/kg/min IV over 5 minutes followed by a maintenance infusion of 0.3-3mg/kg/h IV. Patients in both groups were maintained at Richmond agitation sedation score of -1 to -2. Measurements of HR, NIBP, SpO2 were taken at regular intervals till cessation of sedation and extubation. Data thus collected was subjected to statistical analysis.

Results: Dexmedetomidine was seen to be comparable to propofol as far as maintaining vitals was concerned. Group D (dexmedetomidine) had a statistically significant shorter mean duration to sedation cessation and extubation than group P (propofol). Dexmedetomidine also had the added advantages of minimal respiratory depression, decreased opioid requirements as well as greater cost effectiveness.

Conclusions: Dexmedetomidine was found to be a better choice for sedation in the ICU compared to propofol.


Keywords


ICU sedation, Mean arterial pressure, Richmond agitation sedation score

Full Text:

PDF

References


Rotondi AJ, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, et al. Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Critical care medicine. 2002 Apr 1;30(4):746-52.

Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001 Dec 5;286(21):2703-10.

Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, et al. Current practices in sedation and analgesia for mechanically ventilated critically Ill patientsA prospective multicenter patient-based study. Anesthesiology: J American Society of Anesthesiologists. 2007 Apr 1;106(4):687-95.

Stoll C, Schelling G, Goetz AE, Kilger E, Bayer A, Kapfhammer HP, et al. Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. J thoracic and cardiovascular surgery. 2000 Sep 1;120(3):505-12.

Singh G, Srinivas K. Comparison of Intensive Care Unit Sedation using Dexmedetomidine, Propofol and Midazolam. Int J Sci Stud. 2017;4(10):115-24.

Gerlach AT, Dasta JF. Dexmedetomidine- an updated review. Ann Pharmacother. 2007;41:245-52.

Pollock M. Precedex (dexmedetomidine) Safety and Drug utilization Review- FDA, 2016. Available at: https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisoryCommittee/UCM494470.pdf.

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'neal PV, Keane KA, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. American J respiratory critical care medicine. 2002 Nov 15;166(10):1338-44.

Anger KE, Szumita PM, Baroletti SA, Labrethe MJ, Fanikos J. Evaluation of dexmedetomidine versus propofol based sedation therapy in mechanically ventilated cardiac surgery patients at a tertiary academic medical center. Crit Pathw Cardiol. 2010;9:221-6

Venn RM, Bryant A, Hall GM, Grounds RM. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing sedation in the intensive care unit. Br J Anaesth. 2001;86:650-6.

Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002;95:461-6.

Reichert MG, Jones WA, Royster RL, Slaughter TF, Kon ND, Kincaid EH. Effect of a dexmedetomidine substitution during a nationwide propofol shortage in patients undergoing coronary artery bypass surgery. Pharmacotherapy. 2011;31:673-7.

Hoy SM, Keating GM. Dexmedetomidine: A review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation. Drugs. 2011;71:1481-501.

Eren G, Cukurova Z, Demir G, Hergunsel O, Kozanhan B, Emir NS. Comparison of dexmedetomidine and three different doses of midazolam in preoperative sedation. J Anaesthesiol Clin Pharmacol. 2011;27:367-72.

Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, et al. Dexmedetomidine for long-term sedation investigators: dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012;307(11):1151-60.