Title: Comparison between the Efficacy of Dexmedetomidine, Propofol and Midazolam for Sedation of Mechanically Ventilated Patients in ICU
Authors: Yousry El-Saied Rizk, Ahmed Hamdy Abd El Rahman, Basem Mofreh Aglan, Sa'eed Ahmed Khalil Mady
Introduction: Patients are treated with many interventionsin intensive care units (ICUs) mostly endotracheal intubation and invasive mechanical ventilation that are considered to be stress conditions. Pain is the commonest bad memorythat patients have during the period of their ICU admission. Agitation may cause accidental events such asremoval of endotracheal tubes or intravascular catheters used for monitoring or injection of life-saving medications. Consequently, sedatives and analgesics are widely used in ICUs.
Benzodiazepines like midazolam and lorazepam, Non-benzodiazepines like the short-acting intravenous anesthetic agent like propofol orα2-adrenoceptor agonist sedation like dexmedetomidine. Remifentanil, an opioid, is also used as aunique agent due to its sedative properties. Benzodiazepines action occurs on γ-aminobutyric acid type A (GABAa) receptors, as in part does propofol, however dexmedetomidine is an α2-adrenoceptor agonist, on the other hand remifentanil is a μ-opioid receptor agonist.
Benha University Hospitals in the year of 2018. Patients were divided equally into 3 groups according to receiving of Dexmedetomidine, Propofol or Midazolam.
Group 1: 20 mechanically ventilated patients received Dexmedetomidine with loading dose 1 µg/kg over 10 minutes with I.V injection and follow by maintaining dose 0.2-0.7 µg/kg/h with continuous I.V infusion.
Group 2: 20 mechanically ventilated patients received Propofol with loading dose 1 mg/kg over 5 minutes with I.V injection and follow by maintaining dose 1-3 mg/kg/min with continuous I.V infusion.
Group 3: 20 mechanically ventilated patients received Midazolam with loading dose 0.05 mg/kg with I.V injection and follow by maintaining dose 0.05-0.1 mg/kg/h with continuous I.V infusion.
Studying the efficacy of Dexmedetomidine, Midazolam and Propfol amongmechanically ventilated patient was done according to:
Respiratory rate (RR),Heart rate (HR),Mean arterial blood pressure (MAP),Changes in arterial blood oxygen saturation (SpO2,Length of staying on MV, time of extubation and Occurrence of delirium.
Conclusion: Dexmedetomidine provides hemodynamic stability and has no clinically important adverse effects on respiration also provide less number of patients suffering from delirium.