A RANDOMISED COMPARATIVE STUDY TO EVALUATE THE SAFETY AND EFFICACY OF DEXMEDETOMIDINE VS PROPOFOL FOR SEDATION IN MECHANICALLY VENTILATED PATIENTS.

Dr.Tejaswini Jambotkar; Dr.Kamlesh Gotiwale; Dr.Bharati Tendolkar

Volume : VIII, Issue : II, February - 2019

A RANDOMISED COMPARATIVE STUDY TO EVALUATE THE SAFETY AND EFFICACY OF DEXMEDETOMIDINE VS PROPOFOL FOR SEDATION IN MECHANICALLY VENTILATED PATIENTS.

Dr. Tejaswini Jambotkar, Dr. Kamlesh Gotiwale, Dr. Bharati Tendolkar

Abstract :

Introduction:The intensive care unit (ICU) environment frequently lends itself to being an unpleasant experience for the critically ill patient.One of the key factors in good patient careis appropriate analgesia and sedation to ensurepatient comfort.Traditionally, this has been achieved using benzodiazepines and opioids.The aim of this study was to evaluate and compare FDA approved dexmedetomidine based sedation with the commonly used IV sedative agent in the intensive care unit, namely propofol.

Methodology:A total of 60 postoperative patients expected for 6 to 24 hours on mechanical ventilation were assessed and consent was taken preoperatively. Patients who fulfilled inclusion criteria and exclusion criteria were randomly allocated in group D (Dexmedetomidine) and P (Propofol) according to the computerised randomisation table.Both groups were given infusion for 6 hours or till Ramsay sedation scale(RSS) 3 was reached. Each patient was evaluated hourly for sedation on (RSS), pain on Visual analogue scale(VAS) or Face Rating Scale (FRS) and vital parameters like heart rate, blood pressure, mean arterial pressures (MAP), oxygen saturation were noted for 12 hours.

Results: In our study demographic data was comparable. The results showed that sedation in group D (2.43 + 0.63)and group P (2.77 + 0.43) was comparable. Comparison of pain in both the groups showed VAS score to be significantly less in dexmedetomidine group (P = 0.002) during the infusion. Also, rescue analgesic requirement (fentanyl) was significantly less (P = 0.038) in dexmedetomidine compared to propofol group.Results showed that heart rates were significantly lower (P<0.05) in dexmedetomidine group after the loading dose and also during the maintenance infusion though systolic and diastolic blood pressures, mean arterial pressures and oxygen saturation were similar in both groups.Time to awakening and T– piece respiration was significantly earlier in dexmedetomidine group (P=0.002) compared to propofol. The extubation time was comparatively less in dexmedetomidine group though not statistically significant. The common complication in the study seen was hypotension and adycardia more in dexmedetomidine group.

Conclusion: Dexmedetomidine is a safe alternative to routinely used drugs with equal depth of sedation compared to propofol in postoperative mechanically ventilated patients with advantage of arousability and better patient co–operation during ICU procedures.Dexmedetomidine has good cardiovascular profile with advantage in patients during stressful episodes but needs monitoring the haemodynamics.