Outcome of sedation therapy using midazolam or propofolcontinuous infusion in patients with severe traumaticbrain injury

ObjectivesThe aim of this study was to compare the sedative effect of midazolam and propofol alone or in combination on hemodynamic stability and subsequent intracranial pressure (ICP) changes in adults with severe traumatic brain injury.Patients and methodsAll patients received fentanyl continuous infusion and were randomly divided into three groups: group I received midazolam continuous infusion, group II received propofol continuous infusion, and group III received midazolam and propofol combination at half the dose used for groups I and II. Doses were titrated with gradual increments until the patients were well-sedated irrespective of the upper-dose limit as long as hemodynamic stability was maintained. Intraventicular ICP sensor was inserted at the end of the surgery for patients who underwent surgical interference or through Kocher’s pathway at the right frontal lobe for patients did not undergo surgical interference. Patients were monitored to maintain mean arterial pressure at 80 mmHg or greater and cerebral perfusion pressure and ICP in the range of 50–70 and 18–21 mmHg, respectively. Sedation was judged according to the behavioral pain scale and Bispectral Index.ResultsIntraoperative catheter was applied in 72 patients and through Kocher’s pathway in 48 patients. The catheter was removed without complications in 104 patients (86.7%). The applied therapeutic strategies provided a significant reduction in ICP compared with baseline measures, but with significantly lower ICP in group III compared with other groups. The number of patients who had an ICP less than 21 mmHg was significantly higher in group III compared with other groups. Nineteen patients required mannitol therapy and 20 patients required muscle relaxant infusion, with a significant difference in favor of group III. The mean total Glasgow Coma Scale of patients in group III was significantly higher compared with groups I and II, with a significantly higher difference in favor of group II.ConclusionMidazolam–propofol combination in the used dosage allowed proper control of hemodynamic changes and improved cerebral perfusion pressure with reduction in ICP and minimizing theneed for additional therapy.