A COMPARATIVE STUDY OF MIDAZOLAM, PROPOFOL AND DEXMEDETOMIDINE INFUSIONS FOR SEDATION IN MECHANICALLY VENTILATED PATIENTS IN ICU

Abstract

Background: This study was aimed to compare the sedative properties of study drugs- midazolam, propofol and dexmedetomidine in critically ill patients with GCS of 12-15 on invasive mechanical ventilation.

Methodology: This study was carried out in 75 adult patients with Glasgow coma scale score of 12-15, on mechanical ventilation. The study patients were divided into 3 groups with each group consisting of 25 patients- Group M received inj. Midazolam loading dose 0.15mg/kg intravenous followed by continuous infusion of 0.02-0.1mg/kg/hr, Group P received inj. Propofol loading dose 1.5mg/kg intravenous followed by continuous infusion of 1-6 mg/kg/hr and Group D received inj. Dexmedetomidine loading dose 1µg/kg intravenous followed by continuous infusion of 0.2-0.7 µg/kg/hr. All patients were given study drug infusion for 48 hours to achieve Richmond Agitation Sedation Scale Score 0 to -2. Assessment of RASS score, mean pulse rate, mean arterial pressure, total respiratory rate and SpO₂ were monitored initially at 5 min interval after the loading dose is given, till 30 minutes, then at 1^st hour and 2^nd hour, then at 6^th hour and 12^th hour, then every 12^th hour till 48 hour.

Results: The mean pulse rate and mean arterial pressure decreased after giving loading dose in all three groups and it was more in dexmedetomidine group which continued to be significant till 20 and 30 minutes respectively. RASS remained in the target range of 0 to -2 in all the three groups throughout the sedation period of 48 hours by their infusion doses.

Conclusion: With dexmedetomidine similar levels of sedation can be achieved as compared to propofol and midazolam. All the three drugs are equally efficacious in regard to cardiorespiratory stability in maintaining target sedation (RASS 0 to -2) in mechanically ventilated patients in ICU.