A better drug for extubation-dexmedetomidine or fentanyl

Authors

  • Mohammed Sabir Department of Critical Care Medicine, Renova Neelima Hospital, Hyderabad, India
  • Mirza Najeem Baig Department of Critical Care Medicine, Renova Neelima Hospital, Hyderabad, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20231057

Keywords:

Dexmedetomidine, Fentanyl, Weaning Mechanical ventilation, Intensive care unit

Abstract

Background: Patients on Mechanical ventilator support in intensive care unit (ICU) require analgesia and sedation to facilitate synchronized mechanical ventilation. Our aim of study is to compare the efficacy of dexmedetomidine with Fentanyl to facilitate smooth and shorter time of extubation from mechanical ventilation. The study highlights the characteristics of cardiovascular responses, ventilation, extubation and safety profile of both the drugs.

Methods: A prospective randomized double-blind study was done on total of 40 adults mechanically ventilated patients of either sex, aged 18-60 years were selected. Randomized in two groups of 20 patients each received intravenous infusion of dexmedetomidine (0.2-0.7 mcg/kg/h) or fentanyl infusion (1-2 mcg/kg/h) as needed to maintain Ramsay sedation scale ranging 2-4. Extubation following standard extubation protocol was done. Time for extubation and vital parameters were recorded.

Results: The extubation time in the dexmedetomidine group was significantly lesser than in the fentanyl group. Cardiovascular response was stable in dexmedetomidine group than the Fentanyl group.

Conclusions: Dexmedetomidine facilitates shorter time to extubation, more hemodynamic stability, easy arousability, and lack of respiratory depression.

References

Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471-7.

Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest. 1998;114:541-8.

Arroliga A, Frutos-Vivar F, Hall J, Esteban A, Apezteguía C, Soto L et al. Use of sedatives and neuromuscular blockers in a cohort of patients receiving mechanical ventilation. Chest. 2005;128:496-506.

Bion JF, Ledingham IM. Sedation in intensive care-A postal survey. Intensive Care Med. 1987;13:215-6.

Eckenhoff je, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitment. A clinical survey. Anesthesiology. 1961;22:667-73.

Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:1136-42.

Bloor BC, Ward DS, Belleville JP, Maze M. Effects of IV dexmedetomidine in humans. Hemodynamic-changes. Anesthesiology. 1992;77:1134-42.

Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77:1125-33.

Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000;4:302-8.

Gerlach AT, Dasta JF. Dexmedetomidine: An updated review. Ann Pharmacother. 2007;41:245-52.

Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: A wonder drug? Indian J Anaesth. 2011;55:323-4.

Roerig DL, Kotrly KJ, Vucins EJ. First pass uptake of fentanyl, meperidine, and morphine in the human lung. Anesthesiology. 1987;67(4):466-72.

Gerlach AT, Dasta JF, Steinberg S, Martin LC, Cook CH. A new dosing protocol reduces dexmedetomidine-associated hypotension in critically ill surgical patients. J Crit Care. 2009;24(4):568-74.

Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:113642.

Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699-705.

Gómez-Vázquez ME, Hernández-Salazar E, Hernández-Jiménez A, Pérez-Sánchez A, Zepeda-López VA, Salazar-Páramo M. Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery. J Clin Anesth. 2007;19:576-82.

Taniguchi T, Kidani Y, Kanakura H, Takemoto Y, Yamamoto K. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin-induced shock in rats. Crit Care Med. 2004;32:1322-6.

Rosen DA, Daume JT. Short duration large dose dexmedetomidine in a pediatric patient during procedural sedation. Anesth Analg. 2006;103:68-9.

Pandharipande PP, Pun BT, Herr DL. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients. JAMA. 2007;298:2655-3.

Riker RR, Shehabi Y, Bokesch PM. Dexmedetomidine vs midazolam for sedation of critically ill patients. JAMA. 2009;301:489-99.

Jakob SM, Ruokonen E, Grounds RM. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation. JAMA. 2012;307:1151-60.

Pandharipande PP, Sanders RD, Girard TD. Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial. Critical Care. 2010;14:R38.

Shehabi Y, Ruettimann U, Adamson H, Innes R, Ickeringill M. Dexmedetomidine infusion for more than 24 hours in critically ill patients: Sedative and cardiovascular effects. Intensive Care Med. 2004;30:2188-96.

Arpino PA, Kalafatas K, Thompson BT. Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit. J Clin Pharm Ther. 2008;33:25-30.

Chrysostomou C, Di Filippo S, Manrique AM, Schmitt CG, Orr RA, Casta A et al. Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med. 2006;7:126-31.

Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: Dexmedetomidine versus midazolam. South Med J. 2004;97:451-5.

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Published

2023-04-18

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Original Research Articles