Mohamad, Azlina
(2005)
A comparative study between dexmedetomidine and maxtures of midazolam and morphine for postoperative sedation in intensive care unit.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: The a.2 agonist · dexmedetomidine is a new sedative and analgesic
agent which is licensed in the USA for post-operative intensive care sedation. We
compared dexmedetomidine with the mixture of midazolam and morphine for
post-operative patient who required mechanical ventilation in intensive care unit
(ICU).
Objedive: To compare the effect of dexmedetomidine and midazolam-morphine
mixture among post-operative patients in ICU; in term of the amount of analgesic
(PCA morphine) requirement, s~dation score, haemodynamic profiles and time
of extubation.
Methodology: Prospective, double-blinded randomized controlled trial study
design involved post-operative patients admitted to the Intensive Care Unit {ICU)
of Hospital Universiti Sains Malaysia (HUSM) conducted from June 2003 to June
2004. Thirty-four mechanically ventilated post-operative patients were randomly
assigned to receive short-term (minimum 4 hours) sedation with either
continuous intravenous infusion of dexrnedetomidine (group Dex, n=17) or
midazolam-morphine mixture (group MM, n=17). Both groups received similar
intraoperative anaesthetic regime. Patient controlled analgesia (PCA Morphine)
was given to patient as rescue analgesic. Analgesic (PCA morphine) used
(mg/hour), Ramsay sedation scoring, extubation time (minute), systolic blood
pressure, diastolic blood pressure, mean arterial pressure and heart rate were
Medical Sciences, Universiti s.ains Malaysia had approved this study on 9th April
2003.
Result: Mean extubation time of dexmedetomidine group was significantly lower
than midazolam and morphine mixture group [mean {s.d.): 40.3 ± 16.5 minutes
versus 57.9 ± 17.7 minutes, p=O.OS]. Within the first 4 hours drug infusion, mean
systolic blood pressure [mean (s.d.): 105 ± ·14 mmHg vs 127 ± 24 mmHg,
(p=O.OOO)], mean diastolic blood pressure [mean {s.d.): 59± 8mmHg vs 66 ± 13
mmHg (p=O.OOO)], mean arterial pressure [mean {s.d.): 76 ± 9 mmHg vs 86 ± 15
mmHg (p=O.OOO)] and mean heart rate [mean (s.d.): 88 ± 13 beats per minute vs
102 ± 24 beats per minute (p=O.OOO)] were significantly lower in
dexmedetomidine group than tho!?e in midazolam and morphine mixture. There
was significant difference of mean Ramsay sedation score between
dexmedetomidine and midazolam morphine mixture {p=O.OOO). However, there
was no significant difference of mean dose of morphine per hour between
dexmedetomidine groups and midazolam morphine mixture [(mean (s.d.); 1.4 ±
0.7 mglhour) versus mean (s.d.}; 1.1 ± 0.8 mg/hour), p= 0.157 ].
Conclusion: Dexmedetomidine provides safe, effective sedation and analgesia
for postoperative long surgical patient in intensive care unit. Haemodynamic
variables of dexmedetomidine group was more stable than midazolam and
morphine mixtures group. Thus dexmedetomidine provides better perioperative
haemodynamic control for a _long surgery. The use of d~xmedetomidine also
allowed for more rapid tracheal extubation.
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