Abstract

Dr. Anjum Shamim*, Dr. Arshi Taj, Dr. Mohamad Ommid, Dr. Farhana Bashir and Dr. Fauzia Shifaat

ABSTRACT

Background and Aim: Sedation in the ICU allows for a comfortable and cooperative patient, decreases the level of anxiety and stress, reduces insomnia and the risk of awareness during stressful interventions. The present study was undertaken to evaluate sedative and analgesic properties, safety profile, cardiovascular responses, ventilation and extubation characteristics with dexmedetomidine compared to propofol in postoperative mechanically ventilated patients. Setting and design: 40 postoperative patients admitted in the ICU were selected randomly after taking informed written consent from the relatives.Patients were randomly allocated into 2 groups Group D-Dexmedetomidine group Group P-Propofol Group and prospectively studied using single blinded design. Methods: All patients were randomly allocated to receive intravenous infusions of either dexmedetomidine or propofol whilst being mechanically ventilated, together with the short acting opioid fentanyl for analgesia if required An initial loading dose infusion of dexmedetomidine or propofol was given to rapidly achieve a steady state plasma concentration. The loading dose infusion of dexmedetomidine was 1.0?g/kg-1 over 10 minutes followed by a maintenance infusion of 0.5?g/kg/hr into a peripheral or central vein. Propofol was given undiluted as an infusion of 1-3mg/kg/hr, after a loading dose infusion of 1mg/kg over 10 minutes. Fentanyl was used in IV bolus if required, at 1?g/kg if the patient indicated he or she was in pain. The degree of sedation was measured and recorded hourly using the Ramsay Sedation Score (RSS). The aim with both drugs was to keep patients at RSS > 3 by adjustments to the sedative regimen., safety profile, cardiovascular responses, ventilation and extubation characteristics with dexmedetomidine compared to propofol in postoperative mechanically ventilated patients. Result: In our study we found that dexmedetomidine is an effective and safe agent for postoperative sedation in ICU. The sedative profile of dexmedetomidine was comparable to propofol which is a well established IV sedative agent regularly used in ICU. With the advantage that the opioid requirement was reduced in patients who received dexmedetomidine which could be attributed to central analgesic properties of dexmedetomidine. In this study equipotent sedative doses of these agents infused in patients with similar haemodynamics resulted in equivalent mild reductions in arterial pressures. However the significantly lower heart rate seen with dexmedetomidine in comparison with patients receiving propofol may lower the risk of ischemic events during the stressful ICU episode, in particular over the extubation period. Conclusion: Patients sedated with dexmedetomidine were easily arousable and cooperate well with the ICU staff.