| Propofol versus midazolam: safety and efficacy for sedating the severe trauma patient. | |
| | |
MedLine Citation:
|
PMID: 9620508 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Previous studies have compared sedation profiles with midazolam (Mz) and propofol (Pf), particularly in heterogeneous populations of patients. Decreases in blood pressure and heart rate have been reported after the administration of propofol. These side effects are potentially deleterious in severe trauma patients, particularly in patients with head trauma. To assess the safety and efficacy of Mz and Pf, alone or in combination, in the prolonged sedation of severe trauma patients, we designed a prospective, controlled, randomized, study. One hundred consecutively admitted trauma patients requiring mechanical ventilation and sedation for more than 48 h were studied. Patients were sedated according to three different protocols based on the continuous i.v. administration of Mz alone, Pf alone, and Mz in combination with Pf. All patients received morphine chloride. Safety and efficacy were assessed during the sedation and wake-up periods according to clinical and laboratory variables. Cerebral hemodynamics were also studied in patients with head trauma. Patients were sedated for 6.3 +/- 4.0 days (mean +/- SD). All three sedation regimens were equally efficacious in achieving the desired sedation goal. The incidence of adverse events during the sedation period was also similar. In head trauma patients with intracranial pressure (ICP) monitoring, we did not find differences in ICP, cerebral perfusion pressure, or jugular venous oxygen saturation among the three groups. The serum triglyceride concentration was significantly higher in the Pf group. Wake-up time was significantly shorter in the Pf group. We conclude that both Mz and Pf are safe and efficacious in the sedation of severe trauma patients. The use of Pf in these patients is associated with a high incidence of hypertriglyceridemia and a shorter wake-up time. Implications: In a prospective, controlled, randomized study, we confirmed the safety and efficacy of midazolam and propofol, alone or in combination, in the prolonged sedation of a homogeneous group of severe trauma patients, particularly in patients with head trauma. The propofol group had shorter wake-up times and higher triglyceride levels. |
| | |
Authors:
|
J A Sanchez-Izquierdo-Riera; R E Caballero-Cubedo; J L Perez-Vela; A Ambros-Checa; J A Cantalapiedra-Santiago; E Alted-Lopez |
Related Documents
:
|
14720528 - Overweight and obesity in patients with established coronary heart disease: are we meet... 2191018 - Plasma catecholamine concentration during sedation in ventilated patients requiring int... 6805358 - Disoprofol and fentanyl for total intravenous anaesthesia. 424108 - The effect of internal fetal monitoring on cesarean section morbidity. 15190418 - Antigen modulation followed by quantitative flow cytometry of b-chronic lymphocytic leu... 8777848 - Predictive value of nailfold capillaroscopy in the diagnosis of connective tissue disea... |
Publication Detail:
|
Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
|
Title: Anesthesia and analgesia Volume: 86 ISSN: 0003-2999 ISO Abbreviation: Anesth. Analg. Publication Date: 1998 Jun |
Date Detail:
|
Created Date: 1998-06-19 Completed Date: 1998-06-19 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 1219-24 Citation Subset: AIM; IM |
Affiliation:
|
Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Analgesics, Opioid / therapeutic use Anesthesia Recovery Period Blood Pressure / drug effects Brain / drug effects, physiology Craniocerebral Trauma / therapy* Drug Combinations Female Heart Rate / drug effects Hemodynamics / drug effects Humans Hypnotics and Sedatives / administration & dosage, adverse effects, therapeutic use* Incidence Infusions, Intravenous Intracranial Pressure / drug effects Jugular Veins Male Midazolam / administration & dosage*, adverse effects, therapeutic use* Morphine / therapeutic use Oxygen / blood Propofol / administration & dosage, adverse effects, therapeutic use* Prospective Studies Respiration, Artificial Safety Triglycerides / blood Wounds and Injuries / therapy* |
| Chemical | |
Reg. No./Substance:
|
0/Analgesics, Opioid; 0/Drug Combinations; 0/Hypnotics and Sedatives; 0/Triglycerides; 2078-54-8/Propofol; 57-27-2/Morphine; 59467-70-8/Midazolam; 7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
|
Anesth Analg. 1999 Nov;89(5):1329-30
[PMID:
10553870
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The effects of general versus epidural anesthesia for outpatient extracorporeal shock wave lithotrip...
Next Document: 0.45% saline and 5% dextrose in water, but not 0.9% saline or 5% dextrose in 0.9% saline, worsen bra...