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A comparison between dexmedetomidine and propofol for sedation in the intensive care unit

Introduction

This study compares the highly selective alpha-2 agonist, dexmedetomidine, with propofol for the sedation of postoperative patients requiring mechanical ventilation in the ICU.

Methods

Twenty adult patients expected to require at least 8 h artificial ventilation following major abdominal/pelvic surgery, were randomised to receive sedation with either dexmedetomidine or propofol. Additional analgesia was provided by alfentanil infusions if clinically indicated. Patients received a loading dose of dexmedetomidine 2.5 µg/kg/h over 10 min followed by a maintenance infusion of 0.2-2.5 µg/kg/h. Propofol and alfentanil were infused according to the manufacturers' recommendations. Patients were maintained at a Ramsay Sedation Score >2 by adjustments to the sedative regimen. Heart rate, arterial and central venous pressures were monitored continuously and recorded at 10 min intervals for the first 30 min and then hourly. Venous samples were taken for haematological and biochemical profiles immediately on arrival in the ICU, and then at 24 h and 48 h. Extubation was performed when clinically indicated and time from cessation of sedation infusion to extubation was recorded. Patients completed a questionnaire [1], 48-72 h following discharge from the ICU.

Results

There were no differences in patient and ICU characteristics between the two groups.

Heart rates were significantly lower (P = 0.034) in the dexmedetomidine group. There were no differences in arterial pressure, central venous pressure and haematological/biochemical profiles between the groups.

Conclusion

Dexmedetomidine appears to be safe and acceptable to both clinician and patient in the ICU. Depth of sedation is comparable to propofol and extubation time equally rapid. Furthermore dexmedetomidine provides analgesia and attenuation of the cardiovascular responses to stress, with the potential to minimise ischaemic events.

Supported by Abbott UK.

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Venn, R., Grounds, R. A comparison between dexmedetomidine and propofol for sedation in the intensive care unit. Crit Care 5, P195 (2001). https://doi.org/10.1186/cc1262

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Keywords

  • Central Venous Pressure
  • Dexmedetomidine
  • Alfentanil
  • Cardiovascular Response
  • Sedation Infusion