Bharat Paliwal1, Pyush Rai2, Manoj Kamal3, Geeta Singariya3, Madhu Singhal4, Priyanka Gupta5, Tanuja Trivedi6, Dilip Singh Chouhan7. 1. Assistant Professor, Department of Anesthesiology and Critical Care, Dr.S.N.Medical College , Jodhpur, Rajasthan, India . 2. Final Year Resident, Department of Anesthesiology and Critical Care, Dr.S.N.Medical College , Jodhpur, Rajasthan, India . 3. Associate Professor, Department of Anesthesiology and Critical Care, Dr.S.N.Medical College , Jodhpur, Rajasthan, India . 4. Former Professor and Head, Department of Anesthesiology and Critical care, Dr.S.N.Medical College , Jodhpur, Rajasthan, India . 5. Final Year Resident, Department of Pathology, Netaji Subhash Chandra Bose Medical College , Jabalpur, Madhya Pradesh, India . 6. Senior Resident, Department of Anesthesiology and Critical Care, Dr.S.N.Medical College , Jodhpur, Rajasthan, India . 7. Professor and Head, Department of Anesthesiology and Critical Care, Dr.S.N.Medical College , Jodhpur, Rajasthan, India .
Abstract
BACKGROUND AND AIM: Sedation plays a pivotal role in the care of the critically ill patient. It is equally important to assess depth of sedation. The present study had been designed to compare dexmedetomidine and propofol for sedation in mechanically ventilated intensive care patients. It also intended to verify the clinical validity, reliability and applicability of objective assessment tool bispectral index (BIS) for monitoring sedation and observe for correlation with the commonly used subjective scale, Ramsay sedation score (RSS). MATERIALS AND METHODS: This prospective randomized study was carried out in 60 haemodynamically stable patients, aged between 18 to 80 years, requiring sedation and mechanical ventilation. These were divided equally into two groups. Group A received dexmedetomidine loading dose (1μg/kg) over 10 min followed by maintenance infusion of 0.5μg/kg/hr (0.2-0.7 μg/kg/hr). Group B received propofol loading dose (1mg/kg) over 5 min followed by infusion of 2mg/kg/hr (1-3mg/kg/hr). All patients received fentanyl 1 μg/kg prior to the study drugs. Vital parameters and sedation levels (using RSS and BIS) were monitored for the study period of 12 hours with level 4 or 5 of RSS as target for sedation. Ramsay score was compared with the average of BIS values. Statistical analysis was done using SPSS VERSION 17 software. RESULTS: The study revealed statistically significant lower heart rates during sedation in dexmedetomidine group whereas fall in mean arterial pressure (MAP) following loading dose in propofol group. Patients sedated with dexmedetomidine were easily arousable. Need for rescue drug for achieving the desired RSS as well as incidence of bradycardia was more in dexmedetomidine group than other. Good correlation exists between Ramsay score and BIS values. CONCLUSION:Dexmedetomidine reduces heart rate while propofol transiently affects MAP. However, adequate sedation is achieved with both the drugs. The data obtained from the study validate BIS monitoring for ICU sedation.
RCT Entities:
BACKGROUND AND AIM: Sedation plays a pivotal role in the care of the critically ill patient. It is equally important to assess depth of sedation. The present study had been designed to compare dexmedetomidine and propofol for sedation in mechanically ventilated intensive care patients. It also intended to verify the clinical validity, reliability and applicability of objective assessment tool bispectral index (BIS) for monitoring sedation and observe for correlation with the commonly used subjective scale, Ramsay sedation score (RSS). MATERIALS AND METHODS: This prospective randomized study was carried out in 60 haemodynamically stable patients, aged between 18 to 80 years, requiring sedation and mechanical ventilation. These were divided equally into two groups. Group A received dexmedetomidine loading dose (1μg/kg) over 10 min followed by maintenance infusion of 0.5μg/kg/hr (0.2-0.7 μg/kg/hr). Group B received propofol loading dose (1mg/kg) over 5 min followed by infusion of 2mg/kg/hr (1-3mg/kg/hr). All patients received fentanyl 1 μg/kg prior to the study drugs. Vital parameters and sedation levels (using RSS and BIS) were monitored for the study period of 12 hours with level 4 or 5 of RSS as target for sedation. Ramsay score was compared with the average of BIS values. Statistical analysis was done using SPSS VERSION 17 software. RESULTS: The study revealed statistically significant lower heart rates during sedation in dexmedetomidine group whereas fall in mean arterial pressure (MAP) following loading dose in propofol group. Patients sedated with dexmedetomidine were easily arousable. Need for rescue drug for achieving the desired RSS as well as incidence of bradycardia was more in dexmedetomidine group than other. Good correlation exists between Ramsay score and BIS values. CONCLUSION:Dexmedetomidine reduces heart rate while propofol transiently affects MAP. However, adequate sedation is achieved with both the drugs. The data obtained from the study validate BIS monitoring for ICU sedation.
Entities:
Keywords:
Bispectral index (BIS); Dexmedetomidine; Propofol; Ramsay sedation score (RSS); Sedation in ICU
Authors: Richard R Riker; Yahya Shehabi; Paula M Bokesch; Daniel Ceraso; Wayne Wisemandle; Firas Koura; Patrick Whitten; Benjamin D Margolis; Daniel W Byrne; E Wesley Ely; Marcelo G Rocha Journal: JAMA Date: 2009-02-02 Impact factor: 56.272