European Journal of Biomedical and Pharmaceutical Sciences

COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE AND PROPOFOL FOR PAIN, AGITATION AND DELIRIUM IN INTENSIVE CARE

Sulakshana Sulakshana* and Rajesh Verma

ABSTRACT

Background: Severity of acute medical illness, invasive diagnostic and therapeutic interventions and environmental influences makes the patient prone to pain, agitation and delirium in intensive care units. Several drugs are used for sedation, but it was not clear that whether a single drug is able to address all the three components of pain, agitation and delirium effectively. This study compares dexmedetomidine with propofol in the management of critically- ill patients observing their effect on sedation, pain and delirium scores and other cardio-respiratory parameters. Material & Methods: After clearance from institute ethical committee and written informed consent, patients were randomly divided to two groups of thirty each. Group D received dexmedetomidine intravenous infusion in initial dose of 0.5 mcg/kg/hr over 20 minutes followed by 0.1 mcg/kg/hr, while Group P received propofol (0.5 mg/kg/hr). Infusion rate was titrated to achieve target sedation level. RASS(Richmond agitation sedation scale), CAM-ICU(Confusion assessment method- ICU),and CPOT(Critical care pain observation tool) scores were observed for a duration of 24 hours at baseline, 20 minutes after starting the study drug and subsequently at every four hours duration. Results: Mean RASS in Group D was significantly lower (-0.23 ± 0.50) than group P (0.57 ± 1.17)]. Mean CPOT was also significantly lower (1.30 ± 0.60) in the group D than group P (2.90 ± 1.32). Delirium was also lower (1/30) in the group D than group P (4/30) but this difference was not statistically significant. Conclusion: Both propofol and dexmedetomidine can be used as sedative agent in ICU but dexmedetomidine provides better analgesia and lesser delirium episodes than propofol and thus can be used as sole agent to effectively acts on all the three components pain, agitation and delirium simultaneously.

Keywords: Agitation, delirium, dexmedetomidine, pain, propofol.