Abstract PR116

Abstract

Background & Objectives: The ideal sedative agent should have both sedative and analgesic, minimal cardiovascular side effect, controllable respiratory side effect, rapid onset and offset of action, no accumulation in renal or hepatic dysfunction, has inactive metabolite and minimal interaction with other drugs. The aim of this study was to assess the efficacy between remifentanil and dexmedetomidine in term of haemodynamic, sedation and pain control during weaning in mechanically ventilated ICU patients. Materials & Methods: A prospective, randomized controlled trial was carried out in the SICU, after ethical approval. All patients were started on regular sedation with infusion midazolam and morphine until the decision for weaning was made by the specialist in-charge based on clinical assessment and investigations. During the weaning period, these drugs were discontinued and was replaced by either one of the study drugs. A total of 44 patients in the weaning process, were randomized equally into two groups for sedation in ICU for 6–72 hours. Patients in remifentanil group (R) received remifentanil with dosage range of 6-12microgram/kg/hour. Meanwhile, patient in dexmedetomidine group (D) received dexmedetomidine infusion with a range of 0.2–0.7 microgram/kg/hour. The patients were kept at Richmond Agitation Sedation Scale (RASS) of +1 to -1. Propofol (0.5–4.0 mg/kg/hour) was supplemented only in case of insufficient sedation at maximal remifentanil or dexmedetomidine dose. For remifentanil infusion, the infusion rate was titrated in stages to 0.1mcg/kg/min (6mcg/kg/hour) over a period of one hour prior to extubation. Patient’s haemodynamic RASS and Behavioral Pain Scale were documented. Patients will be excluded if they had not been extubated after 72 hours of starting the study drug infusion. Results: A total of 44 patients were enrolled in this study; 22 patients were given remifentanil infusion and another 22 patients were given dexmedetomidine infusion as sedation in ICU in the weaning process. There was no significant difference for SBP, MAP, HR, sedation score and behavioral pain score between (R) and (D) group during treatment period. However, there was a significant difference in DBP between (R) and (D) group with a mean (95% CI) of 67.29 (56.58, 112.64) and 84.61 (62.87,71.72) during the treatment period. There was a significant difference for sedation score when intragroup comparison for baseline and treatment period in remifentanil group (p =0.01). Similar result also was seen in the dexmedetomidine group, (p = 0.008). Conclusion: In conclusion, both remifentanil and dexmedetomidine regime can be used as sedation in patients with anticipated short-term duration of mechanical ventilation. Both regimes are equally well tolerated. Disclosure of Interest: None declared