Comparison of Dexmedetomidine, midazolam and propofol for sedation of post operative patients on mechanical ventilation- An open label randomised control trial

Abstract

Mechanical ventilation is a life-sustaining therapy for the treatment of patients with acute respiratory failure. One of the key factors for good clinical practice in the ICU is to provide adequate sedation. An ideal sedative should provide a rapid onset, a rapid recovery. On this background the present study is designed to evaluate the efficacy and safety of dexmedetomidine, propofol and midazolam for sedating property, hemodynamic effects and analgesic. It is an open label, single blinded randomized control trial. Census sampling is planned for recruitment which will have maximum power and type I error <0.05.This study is carried out in 39 adult patients with Glasgow coma scale score of 9-15, Patients were divided randomly into three groups of 13 each. Group M patients received IV inj. Midazolam loading dose 0.15mg/kg followed by maintenance dose of 0.02-0.1mg/kg/hour. Group P patients received intravenous inj. Propofol loading dose of 1.5mg/kg followed by continuous infusion of 1-6 mg/kg/hr. Group D patients received intravenous inj. Dexmedetomidine loading dose of 1μg/kg followed by maintenance dose of 0.2-0.5 μg/kg/hr of continuous infusion by infusion pump. Desired depth of sedation was assessed by Ramsay Sedation Score. The difference in mean age and ASA status among the three groups are not statistically significant. There is no statistical significance of sex & GCS status of the patients of these three groups. In our study, difference of mean HR at different time interval was not statistically significant. But the fall in Heart Rate is more in Group D and Group M than in Group P. The mean heart rate is less in Group D compared to Group M and Group P after 45 minutes of infusion. We found that difference of mean SBP & DBP at different time interval was not statistically significant. In overall Dexmedetomidine Group showed stable RSS score throughout the time interval (between RSS 2 to 3). One patient in Dexmedetomidine group developed bradycardia. Mean opioid at 24th hour was significantly higher in group M than other group and difference was statistically significant and post sedation delirium was not statistically significant. In this study we found that difference of mean hemodynamic parameters at different time interval in three drugs was not statistically significant. The Heart Rate remain lower in Dexmedetomidine Group compared to Midazolam and Propofol Group after 45 minutes of infusion.