PROPOFOL VS LOW AND HIGH DOSES OF DEXMEDETOMIDINE FOR SEDATION OF CRITICALLY ILL MECHANICALLY VENTILATED PATIENTS IN ICU

Background: Sedation in the intensive care unit (ICU) should allow the patient to be comfortable, calm, and cooperative, and at the same time easily aroused without delayed weaning and prolonged mechanical ventilation. Objectives: This study aimed at the evaluation and comparison of the use of propofol versus dexmedetomidine in two different dose regimins for prolonged sedation for the mechanically ventilated patients. Methods: 120 patients who were expected to need sedation for mechanical ventilation for 48 to 72 hrs were included in this prospective randomized controlled study. Patients were ASA class II, III and aged between 20-60 years. Patients were allocated into 3 equal groups: group P (n=40) who received propofol (1-4 mg/kg/h), group DL (n=40) who received dexmedetomidine in a lower dose range ( 0.7/µg/kg/h), and group DH (n=40) who received dexmedetomidine in a higher dose range (0.7-1.0/µg/kg/h). Results: The incidence of effective sedation was found to be highest in (group P), less but comparable in (group DH) and least in (group DL). Recovery time was shorter in groups DH and DL compared to group P. There were no statistically significant differences among the 3 groups regarding their hemodynamic stability. As regards the biochemical parameters; there was a statistically significant increase in serum triglyceride levels, serum total cholesterol levels, serum amylase level and serum lipase level in group P after 72 hrs of beginning of sedation compared to groups DH and DL but they all remained within normal ranges. Conclusion: the present study shows that sedation with dexmedetomidine in doses from 0.7-1.0 µg/kg/h can be as effective as, besides being safer than, propofol Dexmedetomidine in doses less than 0.7/µg/kg/hour may be less effective and probably needs supplementation with other sedative.