Comparison of dexmedetomidine and propofol for sedation in patients with traumatic brain injury

Introduction

Both propofol and dexmedetomidine decrease systemic blood pressure, heart rate, and cardiac output in a dose-dependent manner. The aim of this study was to compare their safety and efficacy for intravenous sedation during mechanical ventilation.

Methods

Eighty-four patients with traumatic brain injury (Glasgow scale 7 to 8) entered the study, mean age 44 ± 13.37 years. All patients underwent mechanical lung ventilation. Patients were divided into two groups depending on the type of intravenous sedation. In the first group (n = 42), sedation was performed by intravenous propofol infusion at a dose of 4 to 12 mg/kg/hour. In patients of the second group (n = 42), sedation was carried out by intravenous infusion of dexmedetomidine at a dose of 0.2 to 1.4 mg/kg/hour. The level of sedation was assessed with bispectral index monitoring, targeting index 70. For comparison of methods we evaluated heart rate, blood pressure, SpO₂ 30, 90 and 180 minutes after the start of sedation. Both groups were matched for sex, age and comorbidity.

Results

Thirty minutes after the start of sedation in patients of the first group, HR was 83 ± 11.31 beats/minute, blood pressure was 127 ± 12.87/64 ± 8.54 mmHg, SpO₂ was 97 ± 3.01%. In patients of the second group 30 minutes after the beginning of sedation, HR was 87 ± 10.01 beats/minute, blood pressure was 131 ± 11.67/68 ± 8.19 mmHg, SpO₂ was 97 ± 2.98%. After 90 minutes in the first group of patients, we observed HR was 81 ± 6.27 beats/minute, blood pressure was 119 ± 11.46/59 ± 4.29 mmHg, SpO₂ was 98 ± 2.35%. In the second group, HR was 82 ± 7.31 beats/minute, blood pressure was 94 ± 13.62/55 ± 7.81 mmHg, SpO₂ was 97 ± 2.76%. In the first group 180 minutes after the start of sedation, HR was 86 ± 6.19 beats/minute, blood pressure was 105 ± 10.34/54 ± 4.28 mmHg, SpO₂ was 98 ± 1.32%. In the second group, HR was 75 ± 6.27 beats/minute, blood pressure was 92 ± 12.54/51 ± 6.91 mmHg, SpO₂ was 96 ± 2.91%.

Conclusion

Using dexmedetomidine at a dose of 0.2 to 1.4 mg/kg/hour for intravenous sedation is safe in terms of hemodynamic stability and blood oxygenation for sedation during mechanical lung ventilation in traumatic brain injury patients.