Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of the Efficacy of Midazolam and Dexmedetomidine in Quality of Sedation in Mechanically-Ventilated Patients Admitted to Intensive Care Unit

Document Type : Original Article (s)

Authors
Parviz Kashefi 1
Nazanin Mahinparvar 2
Maryam Khalifsoltani-Khajooie 2
Pejman Mansouri 2
Shahin Sanaei 2
1 Professor, Department of Anesthesiology, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 General Practitioner, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.22122/jims.v35i460.8900
Abstract
Background: Caring for patients with respiratory support is one of the important tasks of intensive care units; sedation of patient during ventilation is important. Therefore, this study aimed to compare the effects of midazolam and dexmedetomidine on the sedation quality of patients undergoing mechanical ventilation in intensive care unit.Methods: This study was performed on 100 patients requiring mechanical ventilation in intensive care unit. Patients were randomly assigned into two equal groups of midazolam and dexmedetomidine; signs and complications were recorded in patients. Chi-square and ANOVA tests were used to compare the data.Findings: Dexmedetomidine, like midazolam, had a good sedation effect. The duration of hospitalization in intensive care unit (9.58 vs. 12.36 days, P = 0.011), and the need for ventilation (3.96 vs. 6.74 days, P < 0.001) were significantly lower in dexmedetomidine group, with no serious complications and hemodynamic changes.Conclusion: According to the efficacy of both drugs, depending on the type of patient and its conditions (sensitivity to a particular type of drug), both drugs can be used to sedate patients undergoing mechanical ventilation.
Keywords
Midazolam
Dexmedetomidine
Sedation
Mechanical Ventilation
  1. Motahedian Tabrizi E, Tadrisi SD, Mohammadyari A, Ebadi A, Mirhashemi S. Validity and reliability of ramsy sedation scale in adult patients hospitalized in critical care units. Iran J Crit Care Nurs 2010; 3(1): 39-44.
  2. Tadrisi SD, Madani SJ, Farmand F, Ebadi A, Karimi Zarchi AA, Saghafinia M, et al. Richmond agitation–sedation scale validity and reliability in intensive care unit adult patients; Persian edition. Iran J Crit Care Nurs 2009; 2(1): 15-21.
  3. Weisbrodt L, McKinley S, Marshall AP, Cole L, Seppelt IM, Delaney A. Daily interruption of sedation in patients receiving mechanical ventilation. Am J Crit Care 2011; 20(4): e90-e98.
  4. Botha JA, Mudholkar P. The effect of a sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit. Crit Care Resusc 2004; 6(4): 253-7.
  5. Elliott R, McKinley S, Aitken LM, Hendrikz J. The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit. Intensive Care Med 2006; 32(10): 1506-14.
  6. Hellstrom J, Owall A, Sackey PV. Wake-up times following sedation with sevoflurane versus propofol after cardiac surgery. Scand Cardiovasc J 2012; 46(5): 262-8.
  7. Simmons LE, Riker RR, Prato BS, Fraser GL. Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale. Crit Care Med 1999; 27(8): 1499-504.
  8. Degrado JR, Anger KE, Szumita PM, Pierce CD, Massaro AF. Evaluation of a local ICU sedation guideline on goal-directed administration of sedatives and analgesics. J Pain Res 2011; 4: 127-34.
  9. Bucknall TK, Manias E, Presneill JJ. A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit. Crit Care Med 2008; 36(5): 1444-50.
  10. Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 2012; 307(11): 1151-60.
  11. Mirkheshti A, Memary E, Nemati Honar B, Jalaeefar A, Sezari P. Local adjuvant dexmedetomidine effect on the dose of sedation during awake endotracheal intubation. Police Med 2016; 5(2): 97-102. [In Persian].
  12. Ghodraty M, Pournajafian A, Rokhtabnak F, Feiz H, Azhdarkosh H, Allame S. Evaluation of intranasal dexmedetomidine in providing moderate sedation in patients undergoing ERCP: A randomized controlled trial. J Mazandaran Univ Med Sci 2016; 26(143): 11-9. [In Persian].
  13. Heard C, Burrows F, Johnson K, Joshi P, Houck J, Lerman J. A comparison of dexmedetomidine-midazolam with propofol for maintenance of anesthesia in children undergoing magnetic resonance imaging. Anesth Analg 2008; 107(6): 1832-9.
  14. Mason KP, Prescilla R, Fontaine PJ, Zurakowski D. Pediatric CT sedation: Comparison of dexmedetomidine and pentobarbital. AJR Am J Roentgenol 2011; 196(2): W194-W198.
  15. Mirkheshti A, Memary E, Shafiee H, Dahi M. Effect of dexmedetomidine infusion on N-terminal pro-B-type natriuretic peptide level in patients with femoral shaft fractures under general anesthesia. Bangladesh J Pharmacol 2016; 11(4): 765-70.
  16. Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: A randomized trial. JAMA 2009; 301(5): 489-99.
Journal of Isfahan Medical School
Volume 35, Issue 460 - Serial Number 460
November and December 2018
Pages 1799-1805

  • Receive Date 04 October 2017
  • Accept Date 06 April 2022