Dexmedetomidine vs. propofol for short-term sedation of postoperative mechanically ventilated patients.

BACKGROUND: Propofol is often used for sedation in the intensive care unit. The aim of this study was to compare the efficacy and endocrine response of propofol vs. the new alpha2-agonist dexmedetomidine for sedation in surgical intensive care patients who need postoperative short-term ventilation.

METHODS: Our work is a randomized clinical study conducted on sixty adult patients who required postoperative short term ventilation and sedation. The patients were allocated randomly, to receive IV infusion of either dexmedetomidine 0.2-0.5 microg/kg/h or propofol 0.5-1 mg/kg/h. Hemodynamic parameters, Ramsay sedation score, extubation time and serum cortisol and interleukin-6 (IL-6) levels were measured.

RESULTS: Ramsay sedation score was 4.1+/-1 and 4+/-0.9 for propofol and dexmedetomidine, respectively, (p=0.59.) Total fentanyl dose in the propofol group was 75+/-15 microg compared to 15+/-10.5 microg in the dexmedetomidine group, (p=0.0045). Patients who received dexmedetomidine infusion had significantly lower heart rates compared to patients who received propofol infusion, (p=0.041). Pre-infusion serum concentrations of IL-6 were comparable in both groups, while the 24 h post-infusion levels were insignificantly decreased in both groups compared to pre-infusion level, (p=0.36). There were no intergroup differences in serum cortisol concentrations (p=0.231).

CONCLUSIONS: Dexmedetomidine and propofol are safe sedative drugs for postoperative mechanichally ventilated patients. Patients were easily aroused to co-operate without showing signs of irritations with less fentanyl analgesia in the dexmedetomidine group. Dexmedetomidine and propofol do not inhibit adrenal function, but they may influence the inflammatory response.