Propofol vs midazolam for ICU sedation : a Canadian multicenter randomized trial. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery Efficacy and safety of dexmedetomidine versus morphine in post-operative cardiac surgery patients Psychoacoustic analysis of noise and the application of earplugs in an ICU: A randomised controlled clinical trial Role of dexmedetomidine in early extubation of the intensive care unit patients The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients Dexmedetomidine vs. propofol for short-term sedation of postoperative mechanically ventilated patients. Comparison of post-operative ICU sedation between dexmedetomidine and propofol in Indian population Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation* Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized controlled trial Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. Sedative Efficacy of Propofol in Patients Intubated/Ventilated after Coronary Artery Bypass Graft Surgery Comparison between dexmedetomidine and midazolam for sedation of eclampsia patients in the intensive care unit. Infusion of propofol versus midazolam for sedation in the intensive care unit following coronary artery surgery. Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. Comparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial. COMPARISON OF PROPOFOL AND MIDAZOLAM FOR SEDATION IN CRITICALLY ILL PATIENTS Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Pain, fentanyl consumption, and delirium in adolescents after scoliosis surgery: dexmedetomidine vs midazolam. Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation Dexmedetomidine versus midazolam for the sedation of patients with non-invasive ventilation failure. Prevalence of Delirium with Dexmedetomidine Compared with Morphine Based Therapy after Cardiac Surgery: A Randomized Controlled Trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study) Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial Cardioprotective effect of sevoflurane and propofol during anaesthesia and the postoperative period in coronary bypass graft surgery: a double-blind randomised study A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients* Propofol versus midazolam for intensive care unit sedation after coronary artery bypass grafting [Comparison of dexmedetomidine and propofol for short-term sedation in early postoperative period after cardiac surgery]. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Midazolam versus propofol for long-term sedation in the ICU: a randomized prospective comparison Impact of clonidine administration on delirium and related respiratory weaning after surgical correction of acute type-A aortic dissection: results of a pilot study. Wake-up times following sedation with sevoflurane versus propofol after cardiac surgery Synergistic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting. Lorazepam and midazolam in the intensive care unit: a randomized, prospective, multicenter study of hemodynamics, oxygen transport, efficacy, and cost. Prolonged sedation of critically ill patients with midazolam or propofol: impact on weaning and costs. [Sedative effects of dexmedetomidine in post-operative elder patients on mechanical ventilation]. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. Prevalence, Risk Factors, and Outcomes of Delirium in Mechanically Ventilated Adults* Dexmedetomidine as an Anesthetic Adjunct in Coronary Artery Bypass Grafting [Comparison of sedative effect of dexmedetomidine and midazolam for post-operative patients undergoing mechanical ventilation in surgical intensive care unit]. [A study of using dexmedetomidine in ventilator bundle treatment in an ICU]. Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium: A Randomized Clinical Trial.
STUDY OBJECTIVES To determine whether sedation with propofol would lead to shorter times to tracheal extubation and ICU length of stay than sedation with midazolam . DESIGN Multicenter , r and omized , open label . SETTING Four academic tertiary-care ICUs in Canada . PATIENTS Critically ill patients requiring continuous sedation while receiving mechanical ventilation . INTERVENTIONS R and om allocation by predicted requirement for mechanical ventilation ( short sedation stratum , < 24 h ; medium sedation stratum , > or = 24 and < 72 h ; and long sedation stratum , > or = 72 h ) to sedation regimens utilizing propofol or midazolam . MEASUREMENTS AND RESULTS Using an intention-to-treat analysis , patients r and omized to receive propofol  in the short sedation  stratum  ( propofol , 21 patients ; midazolam , 26 patients ) and the long sedation stratum ( propofol , 4 patients ; midazolam , 10 patients ) were extubated earlier ( short sedation stratum : propofol , 5.6 h ; midazolam , 11.9 h ; long sedation stratum : propofol , 8.4 h ; midazolam , 46.8 h ; p < 0.05 ) . Pooled results showed that patients treated with propofol ( n = 46 ) were extubated earlier than those treated with midazolam ( n = 53 ) ( 6.7 vs 24.7 h , respectively ; p < 0.05 ) following discontinuation of the sedation but were not discharged from ICU earlier ( 94.0 vs 63.7 h , respectively ; p = 0.26 ) . Propofol-treated patients spent a larger percentage of time at the target Ramsay sedation level than midazolam-treated patients ( 60.2 % vs 44.0 % , respectively ; p < 0.05 ) . Using a treatment-received analysis , propofol sedation either did not differ from midazolam sedation in time to tracheal extubation or ICU discharge ( sedation duration , < 24 h ) or was associated with earlier tracheal extubation but longer time to ICU discharge ( sedation duration , > or = 24 h , < 72 h , or > or = 72 h ) . CONCLUSIONS The use of propofol sedation allowed for more rapid tracheal extubation than when midazolam sedation was employed . This did not result in earlier ICU discharge The aim of this study was to observe the impact of dexmedetomidine on postoperative myocardial injury in patients undergoing off-pump coronary artery bypass ( OPCAB ) grafting . One hundred and sixty-two patients who were undergoing OPCAB surgery were r and omly divided into control and dexmedetomidine groups ( groups C and Dex , respectively ) . Following the first vascular anastomosis grafting , the patients in group Dex received a continuous intravenous infusion of 0.2–0.5 μg/kg/h dexmedetomidine , until they were transferred to the Cardiac Surgery intensive care unit ( ICU ) for 12 h. Patients in group C received physiological saline intraoperatively and an intravenous infusion of 2–4 mg/kg/h isopropylphenol for postoperative sedation . Invasive arterial pressure and heart rate were continuously monitored for 5 min subsequent to entry into the operating theatre ( T0 ) , immediately following surgery ( T1 ) , 12 h post-surgery ( T2 ) , 24 h post-surgery(T3 ) , 48 h post-surgery(T4 ) and 72 h post-surgery ( T5 ) . Blood sample s were taken to determine the plasma levels of cardiac troponin I ( cTnI ) and creatine kinase-MB ( CK-MB ) at each time point . At 72 h post-surgery , a dynamic electrocardiogram was monitored . The blood pressure , heart rate , levels of cTnI , CK-MB , norepinephrine and cortisol , and postoperative arrhythmic events in the patients in group Dex all decreased compared with those in group C. The duration of mechanical ventilation and ICU residence time were also shorter than those in the control group ( P<0.05 ) . Dexmedetomidine reduced post-surgical myocardial injury in patients who had undergone OPCAB surgery Objective To compare the efficacy of dexmedetomidine versus morphine as a sedative/analgesic among post-operative cardiac surgery patients . Method A r and omized controlled open-label study was performed at the cardiothoracic intensive care unit of Penang Hospital , Malaysia . A total of 28 patients who underwent cardiac surgeries were r and omly assigned to receive either dexmedetomidine or morphine . Both groups were similar in terms of preoperative baseline characteristics . Efficacy measures included sedation scores and pain intensity and requirements for additional sedative/analgesic . Mean heart rate and arterial blood pressure were used as safety measures . Other measures were additional inotropes , extubation time and other concurrent medications . Results The mean dose of dexmedetomidine infused was 0.12 [ SD 0.03 ] μg kg−1 h−1 , while that of morphine was 13.2 [ SD 5.84 ] μg kg−1 h−1 . Dexmedetomidine group showed more benefits in sedation and pain levels , additional sedative/analgesic requirements , and extubation time . No significant differences between the two groups for the outcome measures , except heart rate , which was significantly lower in the dexmedetomidine group . Conclusion This preliminary study suggests that dexmedetomidine was at least comparable to morphine in terms of efficacy and safety among cardiac surgery patients . Further studies with larger sample s are recommended in order to determine the significant effects of the outcome measures BACKGROUND Patients and medical staff are exposed to high noise levels in ICUs , which may have a negative impact on their health . Due to the diversity of noise sources present , including the operating noise of medical devices , staff conversations and the unwrapping of disposables , noise profiles are varied . Psychoacoustics deals with the analysis of sound , focusing on its effects on physiological perception and stress . OBJECTIVES The aim of our study was to examine and to classify noise and its psychoacoustic properties in different locations in our ICU at different times . The impact of noise on subjective parameters and stress-related physiological data was also assessed with and without interventional methods . DESIGN A r and omised , controlled , single-blinded clinical trial . SETTING University Hospital , from November 2010 to May 2011 . PATIENTS One hundred and forty-four patients in the ICU . INTERVENTIONS In the first part , multidisciplinary psychoacoustic measurement was performed on the patients in our ICU . In the subsequent clinical trial , patients were equipped with effective earplugs , less effective earplugs and no earplugs . Thereafter , active noise cancellation headphones with or without sound masking were employed on a third patient population . MAIN OUTCOME MEASURES Cortisol and & agr;-amylase in saliva , skin conductance measures , vital signs , psychoacoustic analyses and two st and ardised question naires [ State-Trait Anxiety Inventory ( STAI ) and Hospital Anxiety and Depression Scale ( HADS ) ] were assessed . RESULTS In the first part , the mean ± st and ard deviation ( SD ) subjective loudness was 9.2 ± 4.0 sone . Although absolute sound pressure level and loudness were lower during the night , the number of loud events increased significantly . Skin conductance in the earplug groups was significantly reduced in comparison to that in the control population but not the active noise reduction groups . Nevertheless , noise reduction was found to be comfortable for most patients . CONCLUSION Noise in the ICU is of high clinical relevance . Diverse noise reduction methods , such as earplugs and active noise cancellation , are available . The avoidance of unnecessary noise , however , should be the primary focus . TRIAL REGISTRATION German Clinical Trials Register ( DRKS00000534 ) Background and Aims : Patients on ventilatory support in intensive care unit ( ICU ) require sedation and analgesia to facilitate mechanical ventilation and endotracheal tube tolerance . The selection of the agent should be such that it does not interfere with the early extubation of the patients . We compared the efficacy of dexmedetomidine with midazolam to facilitate extubation of patients from mechanical ventilation in terms of the sedative properties , cardiovascular responses , ventilation , and extubation characteristics and safety profile . Material s and Methods : A total of 40 adult , mechanically ventilated patients of either sex , aged 18 - 60 years , meeting the st and ard criteria for weaning , r and omized into 2 groups of 20 patients each , received intravenous infusion of dexmedetomidine ( 0.2 - 0.7 mcg/kg/h ) or midazolam ( 0.04 - 0.2 mg/kg/h ) as needed for Ramsay sedation scale 2 - 4 . Extubation following st and ard extubation protocol was done . Time for extubation and vital parameters were regularly recorded . Results : The time to extubation in the dexmedetomidine group was significantly lower than in the midazolam group . Heart rate and blood pressure was significantly lower in dexmedetomidine group than the midazolam group at most of the times . Conclusions : Dexmedetomidine has clinical ly relevant benefits compared with midazolam in facilitating extubation due to its shorter time to extubation , more hemodynamic stability , easy arousability , and lack of respiratory depression Introduction This study hypothesised that a reduction of sound during the night using earplugs could be beneficial in the prevention of intensive care delirium .  Two research questions were formulated . First , does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU ? Second , does the use of earplugs during the night improve the quality of sleep in the ICU ? Methods A r and omized clinical trial included adult intensive care patients in an intervention group of 69 patients sleeping with earplugs during the night and a control group of 67 patients sleeping without earplugs during the night . The research ers were blinded during data collection . Assignment was performed by an independent nurse research er using a computer program . Eligible patients had an expected length of stay in the ICU of more than 24 hours , were Dutch- or English-speaking and scored a minimum Glasgow Coma Scale of 10 .  Delirium was assessed using the vali date d NEECHAM scale , sleep perception was reported by the patient in response to five questions . Results The use of earplugs during the night lowered the incidence of confusion in the studied intensive care patients . A vast improvement was shown by a Hazard Ratio of 0.47 ( 95 % confidence interval ( CI ) 0.27 to 0.82 ) . Also , patients sleeping with earplugs developed confusion later than the patients sleeping without earplugs . After the first night in the ICU , patients sleeping with earplugs reported a better sleep perception . Conclusions Earplugs may be a useful instrument in the prevention of confusion or delirium . The beneficial effects seem to be strongest within 48 hours after admission . The relation between sleep , sound and delirium , however , needs further research .Trial registration Current Controlled Trials IS RCT CONTEXT Lorazepam is currently recommended for sustained sedation of mechanically ventilated intensive care unit ( ICU ) patients , but this and other benzodiazepine drugs may contribute to acute brain dysfunction , ie , delirium and coma , associated with prolonged hospital stays , costs , and increased mortality . Dexmedetomidine induces sedation via different central nervous system receptors than the benzodiazepine drugs and may lower the risk of acute brain dysfunction . OBJECTIVE To determine whether dexmedetomidine reduces the duration of delirium and coma in mechanically ventilated ICU patients while providing adequate sedation as compared with lorazepam . DESIGN , SETTING , PATIENTS , AND INTERVENTION Double-blind , r and omized controlled trial of 106 adult mechanically ventilated medical and surgical ICU patients at 2 tertiary care centers between August 2004 and April 2006 . Patients were se date d with dexmedetomidine or lorazepam for as many as 120 hours . Study drugs were titrated to achieve the desired level of sedation , measured using the Richmond Agitation-Sedation Scale ( RASS ) . Patients were monitored twice daily for delirium using the Confusion Assessment Method for the ICU ( CAM-ICU ) . MAIN OUTCOME MEASURES Days alive without delirium or coma and percentage of days spent within 1 RASS point of the sedation goal . RESULTS Sedation with dexmedetomidine result ed in more days alive without delirium or coma ( median days , 7.0 vs 3.0 ; P = .01 ) and a lower prevalence of coma ( 63 % vs 92 % ; P < .001 ) than sedation with lorazepam . Patients se date d with dexmedetomidine spent more time within 1 RASS point of their sedation goal compared with patients se date d with lorazepam ( median percentage of days , 80 % vs 67 % ; P = .04 ) . The 28-day mortality in the dexmedetomidine group was 17 % vs 27 % in the lorazepam group ( P = .18 ) and cost of care was similar between groups . More patients in the dexmedetomidine group ( 42 % vs 31 % ; P = .61 ) were able to complete post-ICU neuropsychological testing , with similar scores in the tests evaluating global cognitive , motor speed , and attention functions . The 12-month time to death was 363 days in the dexmedetomidine group vs 188 days in the lorazepam group ( P = .48 ) . CONCLUSION In mechanically ventilated ICU patients managed with individualized targeted sedation , use of a dexmedetomidine infusion result ed in more days alive without delirium or coma and more time at the targeted level of sedation than with a lorazepam infusion . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00095251 Background and Objectives : Patients on mechanical ventilation in intensive care unit ( ICU ) are often uncomfortable because of anxiety , pain , and endotracheal intubation ; therefore , require sedation . Alpha-2 agonists are known to produce sedation . We compared clonidine and dexmedetomidine as sole agents for sedation . Study Design : Prospect i ve , r and omized , controlled open-label study . Material s and Methods : A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation , were r and omly allocated into two groups . Group C ( n = 35 ) received intravenous ( IV ) clonidine ( 1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation ) , and Group D ( n = 35 ) received IV dexmedetomidine for sedation ( loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation ) . A Ramsay Sedation Score of 3 - 4 was considered as target sedation . Additional sedation with diazepam was given when required to achieve target sedation . The quality of sedation , hemodynamic changes and adverse effects were noted and compared between the two groups . Results : Target sedation was achieved in 86 % observations in Group D and 62 % in Group C ( P = 0.04 ) . Additional sedation was needed by more patients in Group C compared with Group D ( 14 and 8 in Groups C and D , respectively , P = 0.034 ) , mainly due to concomitant hypotension on increasing the dose of clonidine . Hypotension was the most common side-effect in Group C , occurring in 11/35 patients of Group C and 3/35 patients of Group D ( P = 0.02 ) . Rebound hypertension was seen in four patients receiving clonidine , but none in receiving dexmedetomidine . Conclusion : Both clonidine and dexmedetomidine  produced effective sedation ; however , the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients BACKGROUND Propofol is often used for sedation in the intensive care unit . The aim of this study was to compare the efficacy and endocrine response of propofol vs. the new alpha2-agonist dexmedetomidine for sedation in surgical intensive care patients who need postoperative short-term ventilation . METHODS Our work is a r and omized clinical study conducted on sixty adult patients who required postoperative short term ventilation and sedation . The patients were allocated r and omly , to receive IV infusion of either dexmedetomidine 0.2 - 0.5 microg/kg/h or propofol 0.5 - 1 mg/kg/h .  Hemodynamic parameters , Ramsay sedation score , extubation time and serum cortisol and interleukin-6 ( IL-6 ) levels were measured . RESULTS Ramsay sedation score was 4.1+/-1 and 4+/-0.9 for propofol and dexmedetomidine , respectively , ( p=0.59 . ) Total fentanyl dose in the propofol group was 75+/-15 microg compared to 15+/-10.5 microg in the dexmedetomidine group , ( p=0.0045 ) . Patients who received dexmedetomidine infusion had significantly lower heart rates compared to patients who received propofol infusion , ( p=0.041 ) . Pre-infusion serum concentrations of IL-6 were comparable in both groups , while the 24 h post-infusion levels were insignificantly decreased in both groups compared to pre-infusion level , ( p=0.36 ) . There were no intergroup differences in serum cortisol concentrations ( p=0.231 ) . CONCLUSIONS Dexmedetomidine and propofol are safe sedative drugs for postoperative mechanichally ventilated patients . Patients were easily aroused to co-operate without showing signs of irritations with less fentanyl analgesia in the dexmedetomidine group . Dexmedetomidine and propofol do not inhibit adrenal function , but they may influence the inflammatory response Context : Critically ill patients requiring mechanical ventilation frequently need sedatives and analgesics to facilitate their care . Dexmedetomidine , a short-acting alpha-2-agonist , possesses anxiolytic , anesthetic , hypnotic , and analgesic properties . Aims : The objective of this study was to evaluate the efficacy and safety of dexmedetomidine in comparison to propofol in the management of sedation for post-operative intensive care unit ( ICU ) patients , as a sedative agent . Setting s and Design : Teaching hospital , A phase III , prospect i ve , open , r and omized and comparative . Material s and Methods : Thirty patients who were ambulatory and who required the post-operative mechanical ventilation or post-operative sedation were enrolled , in which 15 patients received Dexmedetomidine and remaining 15 patients received propofol . All these patients were treated for the period of 8 to 24 h. Statistical Analysis Used : Data were analyzed using Student 's t-test and Chi-square test . The value of P < 0.05 was considered as statistically significant . Results : Demographic data were comparable . Pulse rate , respiratory rate and blood pressure were comparable . Depth of sedation and extubation time were similar . To maintain analgesia throughout the study period , patients receiving propofol infusions required significantly more analgesics than patients receiving Dexmedetomidine . Conclusions : Dexmedetomidine appears to be a safe and acceptable ICU sedative agent when both the clinician 's and patient 's perspectives are considered Objective : Dexmedetomidine ( DEX ) may provide a sedation level that enables sleep and communication , with less amnesia and pain medication requirements , during mechanical ventilation . Our study directly assessed patient-perceived satisfaction with coronary artery bypass graft surgery after administration of DEX or propofol for intensive care unit ( ICU ) sedation . Design : Prospect i ve , r and omized clinical study with subsequent question naire administration . Setting : Tertiary care surgical ICU . Patients : A total of 89 adult , nonemergent , coronary artery bypass graft patients with an expected length of intubation of < 24 hrs . Interventions : Patients were r and omized to either DEX or propofol ; drug administration was performed via st and ardized anesthesia and nursing protocol s. Measurements : Patients reported perceptions of their ICU experience after mechanical ventilation with a modified numerical-scale Hewitt question naire , vali date d specifically for ICU patients . Patients were question ed regarding awareness , recall , generalized comfort , level of pain , ability to interact with healthcare providers and family , feelings of agitation and anxiety , perceived ease of extubation , ability to sleep or rest , and satisfaction with ICU experience . Main Results : Groups were well matched at baseline , with a mean ± sd age of 63.0 ± 10.4 yrs and weight of 88.7 ± 16.7 kg . No difference was observed for length of surgery , length of intubation , or ICU stay ( p > .05 ) . DEX patients perceived a shorter length of intubation ( p = .044 ) . A deeper sedation level was found in the propofol group ( p = .021 ) , with similar morphine and midazolam requirements ( p = .317 ) . Patient-rated level of overall awareness as a marker of amnesia did not differ between groups ( p = .653 ) . The ability to rest or sleep trended toward significance favoring propofol ( p = .051 ) . On evaluation of question naire ratings , DEX patients expressed more discomfort ( p = .046 ) , pain ( p = .096 ) , and sleeping difficulty ( p = .036 ) . Similar comfort levels were reported during extubation ( p = .179 ) . Conclusions : Despite theoretical advantages of DEX to improve overall patient satisfaction , the two agents provide similar responses to amnesia and pain control . According to our findings , DEX does not seem to have any advantage compared with propofol for short-term sedation after coronary artery bypass graft surgery Introduction Agitated delirium is common in patients undergoing mechanical ventilation , and is often treated with haloperidol despite concerns about safety and efficacy . Use of conventional sedatives to control agitation can preclude extubation . Dexmedetomidine , a novel sedative and anxiolytic agent , may have particular utility in these patients . We sought to compare the efficacy of haloperidol and dexmedetomidine in facilitating extubation . Methods We conducted a r and omised , open-label , parallel-groups pilot trial in the medical and surgical intensive care unit of a university hospital . Twenty patients undergoing mechanical ventilation in whom extubation was not possible solely because of agitated delirium were r and omised to receive an infusion of either haloperidol 0.5 to 2 mg/hour or dexmedetomidine 0.2 to 0.7 μg/kg/hr , with or without loading doses of 2.5 mg haloperidol or 1 μg/kg dexmedetomidine , according to clinician preference . Results Dexmedetomidine significantly shortened median time to extubation from 42.5 ( IQR 23.2 to 117.8 ) to 19.9 ( IQR 7.3 to 24 ) hours ( P = 0.016 ) . Dexmedetomidine significantly decreased ICU length of stay , from 6.5 ( IQR 4 to 9 ) to 1.5 ( IQR 1 to 3 ) days ( P = 0.004 ) after study drug commencement . Of patients who required ongoing propofol sedation , the proportion of time propofol was required was halved in those who received dexmedetomidine ( 79.5 % ( 95 % CI 61.8 to 97.2 % ) vs. 41.2 % ( 95 % CI 0 to 88.1 % ) of the time intubated ; P = 0.05 ) . No patients were reintubated ; three receiving haloperidol could not be successfully extubated and underwent tracheostomy . One patient prematurely discontinued haloperidol due to QTc interval prolongation . Conclusions In this preliminary pilot study , we found dexmedetomidine a promising agent for the treatment of ICU-associated delirious agitation , and we suggest this warrants further testing in a definitive double-blind multi-centre trial . Trial registration Clinical trials.gov Introduction Intensive care unit ( ICU ) environmental factors such as noise and light have been cited as important causes of sleep deprivation in critically ill patients . Previous studies indicated that using earplugs and eye masks can improve REM sleep in healthy subjects in simulated ICU environment , and improve sleep quality in ICU patients . This study aim ed to determine the effects of using earplugs and eye masks with relaxing background music on sleep , melatonin and cortisol levels in ICU patients . Methods Fifty patients who underwent a scheduled cardiac surgery and were expected to stay at least 2 nights in Cardiac Surgical ICU ( CSICU ) were included . They were r and omized to sleep with or without earplugs and eye masks combined with 30-minute relaxing music during the postoperative nights in CSICU . Urine was analyzed for nocturnal melatonin and cortisol levels . Subjective sleep quality was evaluated using the Chinese version of Richards-Campbell Sleep Question naire ( a visual analog scale , ranging 0–100 ) . Results Data from 45 patients ( 20 in intervention group , 25 in control group ) were analyzed . Significant differences were found between groups in depth of sleep , falling asleep , awakenings , falling asleep again after awakening and overall sleep quality ( P < 0.05 ) . Perceived sleep quality was better in the intervention group . No group differences were found in urinary melatonin levels and cortisol levels for the night before surgery , and the first and second nights post-surgery ( P > 0.05 ) . The urinary melatonin levels of the first and second postoperative nights were significantly lower than those of the night before surgery ( P = 0.01 ) . The opposite pattern was seen with urinary cortisol levels ( P = 0.00 ) . Conclusion This combination of non-pharmacological interventions is useful for promoting sleep in ICU adult patients ; however , any influence on nocturnal melatonin levels and cortisol level may have been masked by several factors such as the timing of surgery , medication use and individual differences . Larger scale studies would be needed to examine the potential influences of these factors on biological markers and intervention efficacy on sleep . Trial registration Chinese Clinical Trial Registry : ChiCTR-IOR-14005511 . Registered 21 November 2014 BACKGROUND We evaluated the use of dexmedetomidine to facilitate the weaning of delirious postoperative patients from mechanical ventilation . METHODS We included 72 consecutive patients who underwent elective cardiac surgery in this prospect i ve observational study . Each patient had failed at least 1 trial of continuous positive airway pressure ( CPAP ) and had agitation . Patients were assessed with the Richmond Agitation-Sedation Scale ( RASS ) and the Confusion Assessment Method for the Intensive Care Unit ( CAMICU ) 12 to 18 hours after their admission to the ICU . Midazolam and fentanyl were then given to all patients according to the sedation protocol . At 36 hours in the ICU , patients who had agitation and an inability to wean were r and omly divided into 2 groups : group M , 34 patients who continued to follow the routine sedative protocol ; and group D , 38 patients who were given dexmedetomidine .  Arterial blood gas measurements , hemodynamic parameters , and time to extubation were recorded . Statistical analysis was performed with GraphPad InStat ( version 2.02 for DOS ) . RESULTS All patients tested positive in the CAM-ICU assessment , and all had a delirium diagnosis . The 38 patients in group D tolerated a spontaneous breathing trial with CPAP and were extubated after a mean ( ±SD ) of 49.619 ± 6.96 hours . The 2 groups had significantly different extubation times ( 58.389 ± 3.958 hours versus 49.619 ± 6.96 hours ) . The 2 groups had significantly different RASS scores at 48 and 60 hours and significantly different heart rates and PO2 values at 12 and 24 hours . The 2 groups showed no significant differences with regard to hemodynamic parameters . CONCLUSIONS Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery Background : Sedation after open heart surgery is important in preventing stress on the heart . The unique sedative features of propofol prompted us to evaluate its potential clinical role in the sedation of post-CABG patients . Objectives : To compare propofol-based sedation to midazolam-based sedation after coronary artery bypass graft ( CABG ) surgery in the intensive care unit ( ICU ) . Patients and Methods : Fifty patients who were admitted to the ICU after CABG surgery was r and omized into two groups to receive sedation with either midazolam or propofol infusions ; and additional analgesia was administered if required . Inclusion criteria were as follows : patients 40 - 60 years old , hemodynamic stability , ejection fraction ( EF ) more than 40 % ; exclusion criteria included patients who required intra-aortic balloon pump or inotropic drugs post-bypass . The same protocol of anesthetic medications was used in both groups . Depth of sedation was monitored using the Ramsay sedation score ( RSS ) . Invasive mean arterial pressure ( MAP ) and heart rate ( HR ) , arterial blood gas ( ABG ) and ventilatory parameters were monitored continuously after the start of study drug and until the patients were extubated . Results : The depth of sedation was almost the same in the two groups ( RSS=4.5 in midazolam group vs 4.7 in propofol group ; P = 0.259 ) but the total dose of fentanyl in the midazolam group was significantly more than the propofol group ( 12.5 mg/hr vs 4 mg/hr ) ( P = 0.0039 ) . No significant differences were found in MAP ( P = 0.51 ) and HR ( P = 0.41 ) between the groups . The mean extubation time in patients se date d with propofol was shorter than those se date d with midazolam ( 102 ± 27 min vs 245 ± 42 min , respectively ; P < 0.05 ) but the ICU discharge time was not shorter ( 47.5 hr vs 36.3 hr , respectively ; P = 0.24 ) . Conclusions : Propofol provided a safe and acceptable sedation for post-CABG surgical patients , significantly reduced the requirement for analgesics , and allowed for more rapid tracheal extubation than midazolam but did not result in earlier ICU discharge PURPOSE This study compares the effectiveness of midazolam and dexmedetomidine for the sedation of eclampsia patients admitted to our intensive care unit ( ICU ) . PATIENTS AND METHODS Forty women with eclampsia requiring termination of pregnancy by caesarean delivery were r and omized in to 2 groups of 20 to receive either midazolam or dexmedetomidine . The midazolam group received a loading dose of 0.05 mg/kg followed by an infusion of 0.1 mg kg(-1 ) h(-1 ) . The dexmedetomidine group loading dose was 1 microg/kg per 20 minutes , followed by continuous infusion at 0.7 microg kg(-1 ) h(-1 ) . Heart rate , blood pressure , Ramsey sedation score , antihypertensive need , convulsion fits , and duration in ICU were monitored and recorded all through the ICU stay . RESULTS Dexmedetomidine markedly reduced heart rates for the first 24 hours ( P < .05 ) compared with midazolam , but there were no differences at 48 and 72 hours . Mean arterial blood pressures were similar in the 2 groups ( P > .05 ) , although in the dexmedetomidine group , it was lower at 5 , 6 , 12 , and 24 hours compared with the first 4 hours ( P < .05 ) . Moreover , fewer patients given dexmedetomidine required nitroglycerine and nitroprusside ( P < .05 ) . The duration of ICU stay was less in the dexmedetomidine group , 45.5 hours ( range , 15 - 118 hours ) , than in the midazolam group , 83 hours ( minimum-maximum , 15 - 312 hours ) . CONCLUSION Dexmedetomidine sedation in eclampsia patients is effective in reducing the dem and for antihypertensive medicine and duration of ICU stay The use and the hemodynamic effects of propofol and midazolam were studied during titrated continuous infusions to deep sedation ( sedation level 5 : asleep , sluggish response to light glabellar tap or loud auditory stimulus ) following coronary artery surgery . The drugs were compared in 30 ventilated patients in an open r and omized study . The duration of infusion was approximately 570 minutes in both groups . After a loading dose of propofol ( 1 mg/kg ) or midazolam ( 0.07 mg/kg ) , the infusion rates were 2.71 + /- 1.13 mg/kg/h and 0.092 + /- 0.028 mg/kg/h , respectively . An analgesic infusion of sufentanil was also given in both groups . In the midazolam group , to maintain the predetermined level of sedation , more frequent additional bolus doses ( 4.7 + /- 1.8 ; P < 0.001 ) and infusion rate adjustments ( 5.3 + /- 1.6 ; P < 0.001 ) were required than for similar sedation in the propofol group ( 2.3 + /- 1.0 bolus doses and 3.3 + /- 1.2 adjustments ) . The time from stopping sedation to patient responsiveness was 11 + /- 8 minutes in the propofol group and 72 + /- 70 minutes in the midazolam group ( P < 0.001 ) , and the time from stopping sedation to extubation was 250 + /- 135 minutes and 391 + /- 128 minutes ( P < 0.014 ) , respectively . Following the loading dose of propofol , there was a fall in blood pressure ( BP ) ( mean from 80 + /- 11 mmHg to 67.5 + /- 10 mmHg ; P < 0.05 ) . After approximately 15 minutes , BP started to rise but remained below pretreatment level throughout sedation . ( ABSTRACT TRUNCATED AT 250 WORDS STUDY OBJECTIVE To compare the effects of an intravenous infusion of propofol and the alpha-2 adrenoceptor , dexmedetomidine , on inflammatory responses and intraabdominal pressure ( IAP ) in severe sepsis after abdominal surgery , specifically , serum cytokine levels ( interleukin [IL]-1 , IL-6 , and tumor necrosis factor [TNF]-alpha ) and IAP . DESIGN Prospect i ve , single-center study . SETTING University hospital . PATIENTS 40 adult ICU patients who had undergone ileus surgery and who were expected to require postoperative sedation and ventilation . INTERVENTIONS Patients received either a loading dose infusion of propofol ( Group P ; n = 20 ) one mg/kg over 15 minutes followed by a maintenance dose of one to three mg/kg/hr ( n = 20 , Group P ) or a loading dose of dexmedetomidine of one microg/kg over 10 minutes followed by a maintenance dose of 0.2 - 2.5 microg/kg/h ( n = 20 , Group D ) at the 24th hour . MEASUREMENTS Biochemical and hemodynamic parameters , cytokine levels , and IAP were recorded before the start of the study and at the 24th and 48th hours . MAIN RESULTS TNF-alpha levels were significantly lower at the 24th hour ( 14.66 + /- 4.40 pg/mL vs. 21.21 + /- 11.37 pg/mL , respectively ) and at the 48th hour ( 21.25 + /- 15.85 pg/mL vs. 46.55 + /- 35.99 pg/mL , respectively ) in Group D. IL-1 levels were significantly lower at the 24th hour ( 5.03 + /- 0.15 pg/mL vs. 6.23 + /- 2.09 pg/mL , respectively ) and the 48th hour ( 5.01 + /- 0.37 pg/mL vs. 6.42 + /- 2.76 pg/mL , respectively ) in Group D. IL-6 levels were significantly lower at the 24th hour ( 253.1 + /- 303.6 pg/mL and 511.3 + /- 374.8 pg/mL , respectively ) and at the 48th hour ( 343.5 + /- 393.4 pg/mL and 503.7 + /- 306.4 pg/mL , respectively ) in Group D. Intraabdominal pressure also was significantly lower at the 24th hour ( 12.35 + /- 5.84 mmHg vs. 18.1 + /- 2.84 mmHg , respectively ) and the 48th hour ( 13.9 + /- 6.15 mmHg vs. 18.7 + /- 3.46 mmHg , respectively ) in Group D. CONCLUSION Dexmedetomidine infusion decreases TNF-a , IL-1 , and IL-6 levels and IAP more than a propofol infusion OBJECTIVES To compare the effectiveness , characteristics , duration of action , hemodynamic and biochemical effects , and side effects of propofol and midazolam used for continuous intravenous sedation of ventilated critically ill patients . DESIGN Multicenter , prospect i ve , r and omized , nonblinded study . SETTING Nine Spanish general intensive care units ( ICUs ) . PATIENTS Ninety-eight patients admitted to the ICU who were mechanically ventilated and required sedation for a minimum of 48 hrs . INTERVENTIONS Propofol or midazolam was used for induction and maintenance of continuous intravenous sedation for a maximum of 5 days . The effectiveness of those two regimens was assessed according to their effects on ventilatory management and the presence of agitation . MEASUREMENTS AND MAIN RESULTS In 93 % of the patients studied , there was a medical cause necessitating mechanical ventilation . The mean ( + /-SD ) duration of sedation was 81 + /- 25 hrs and 88 + /- 27 hrs for the propofol and midazolam groups , respectively . The induction dose was 2.24 + /- 0.43 mg/kg over 318 + /- 363 secs for propofol , and 0.22 + /-0.07 mg/kg over 33 + /-29 secs for midazolam . The maintenance dose was 2.8 + /-1.1 mg/kg/hr for propofol and 0.14 + /- 0.10 mg/kg/hr for midazolam . There was no difference regarding the opiate and muscle relaxant requirements between the two groups . Sedation with propofol was more effective in achieving patient-ventilator synchrony than that with midazolam after the first hour of treatment ( p < .01 ) . Patients se date d with propofol awoke more rapidly and with less variability that those patients se date d with midazolam ( 23 + /- 16 mins vs. 137 + /- 185 mins , respectively , p < .05 ) , particularly in those patients requiring deep sedation ( 27 + /- 16 mins vs. 237 + /- 222 mins , respectively , p < .01 ) . No hemodynamic or biochemical changes were detected in any of the treatment groups . During induction , five patients in the propofol group and two patients in the midazolam group had hypotension . CONCLUSIONS In this population of critically ill patients , propofol is an effective and safe alternative for sedation , with some advantages , such as short duration of action and high effectiveness over the conventional regimen with benzodiazepines and opiates 101 critically ill patients admitted to five intensive-care units were allocated r and omly to receive a continuous intravenous infusion of either propofol or midazolam for sedation for up to 24 h. In addition , morphine was given to provide analgesia . The mean duration of infusion was 20.2 h ( range 3.0 - 24.5 ) in the propofol group and 21.3 h ( 4.0 - 47.0 ) in the midazolam group and infusion rates were 1.77 mg/kg/h ( range 0.40 - 5.00 ) and 0.10 mg/kg/h ( 0.01 - 0.26 ) , respectively . The infusion rates were adjusted as necessary , and the desired level of sedation was achieved easily in most patients in both groups . There were slight falls in arterial pressure , but there were no significant differences between the groups . Heart rate was lower in patients who received propofol . Some small changes occurred in biochemical and haematological variables in both groups , but they were not clinical ly significant . There was no indication that either drug substantially impaired adrenal steroidogenesis . When the infusion was discontinued , there was less variability in recovery of consciousness in patients who had received propofol . In a subgroup of patients , weaning from mechanical ventilation was achieved significantly faster after discontinuation of propofol than of midazolam . Propofol proved to be a satisfactory agent for sedation of these critically ill patients and compared favourably with midazolam BACKGROUND Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances . OBJECTIVE The authors investigated the effects of postoperative sedation on the development of delirium in patients undergoing cardiac-valve procedures . METHODS Patients underwent elective cardiac surgery with a st and ardized intraoperative anesthesia protocol , followed by r and om assignment to one of three postoperative sedation protocol s : dexmedetomidine , propofol , or midazolam . RESULTS The incidence of delirium for patients receiving dexmedetomidine was 3 % , for those receiving propofol was 50 % , and for patients receiving midazolam , 50 % . Patients who developed postoperative delirium experienced significantly longer intensive-care stays and longer total hospitalization . CONCLUSION The findings of this open-label , r and omized clinical investigation suggest that postoperative sedation with dexmedetomidine was associated with significantly lower rates of postoperative delirium and lower care costs BACKGROUND The study aim was to compare the efficacy of dexmedetomidine vs midazolam for sedation during the early postoperative period in adolescents who underwent scoliosis surgery . METHODS We performed a prospect i ve , r and omized trial in an intensive care unit ( ICU ) in a tertiary care center . In this study , 42 patients ( American Society of Anesthesiology physical status I and II ) who underwent scoliosis surgery were divided into two groups according to sedation protocol s : group dexmedetomidine ( DEX ) ( n = 22 ) and group midazolam ( MDZ ) ( n = 20 ) . Adolescents ( 12 - 18 years ) requiring mechanical ventilation underwent a continuous infusion of either dexmedetomidine ( group DEX ; starting dose , 0.4 μg·kg(-1 ) · h(-1 ) ) or midazolam ( group MDZ ; starting dose , 0.1 mg·kg(-1 ) · h(-1 ) ) with intermittent fentanyl , as needed . The efficacy of sedation was assessed using the Richmond Agitation Sedation Scale ( RASS ) . Quality of pain relief was measured using the Numeric Visual Analog Scale ( NVAS ) . Delirium was determined in patients in the RASS range of -2 to + 1 using the Confusion Assessment Method for the ICU ( CAM-ICU ) . Fentanyl consumption , incidence of delirium , NVAS scores , and hemodynamics were recorded postoperatively at 2 , 4 , 6 , and 24 h in the ICU . RESULTS The NVAS pain scores and fentanyl consumption at all the evaluation time points were significantly higher in group MDZ than those in group DEX ( P < 0.05 ) . Further , total fentanyl consumption in group MDZ was significantly higher than that in group DEX ( P < 0.05 ) . Delirium was significantly higher in the group MDZ than that in group DEX ( 31.3 % vs 12.5 % ) when analyzed as the endpoint of CAM-ICU ( P < 0.05 ) . The heart rate was significantly lower in group DEX compared with that in group MDZ at all the evaluation time points ( P < 0.05 ) . CONCLUSION Dexmedetomidine was associated with the decreased postoperative fentanyl consumption , NVAS scores , and a decreased incidence of delirium . These findings may be beneficial for managing sedation protocol s in adolescents who have undergone scoliosis surgery Purpose To compare dexmedetomidine ( DEX ) with st and ard care ( SC , either propofol or midazolam ) for long-term sedation in terms of maintaining target sedation and length of intensive care unit ( ICU ) stay . Methods A pilot , phase III , double-blind multicenter study in r and omized medical and surgical patients ( n = 85 ) within the first 72 h of ICU stay with an expected ICU stay of ≥48 h and sedation need for ≥24 h after r and omization . Patients were assigned to either DEX ( ≤1.4 μg kg−1 h−1 ; n = 41 ) or SC ( n = 44 ) , with daily sedation stops . Results Non-inferiority of DEX versus SC was not confirmed . Target Richmond agitation – sedation score ( RASS ) was reached a median of 64 % ( DEX ) and 63 % ( SC ) of the sedation time ( ns ) . The length of ICU stay was similar in DEX and SC . Patients with RASS target 0–3 ( DEX 78 % , SC 80 % ) were at target sedation 74 % ( DEX ) and 64 % ( SC ) of the time ( ns ) , whereas those with RASS target −4 or less reached the target 42 % ( DEX ) and 62 % ( SC ) of the time ( P = .006 ) . Post hoc analyses suggested shorter duration of mechanical ventilation  for DEX ( P = 0.025 ) . Conclusions This pilot study suggests that in long-term sedation  , DEX is comparable to SC in maintaining sedation targets of RASS 0 to −3 but not suitable for deep sedation ( RASS −4 or less ) . DEX had no effect on length of ICU stay . Its effects on other relevant clinical outcomes , such as duration of mechanical ventilation , should be tested further OBJECTIVE To compare the efficacy and safety of sedation with dexmedetomidine vs. midazolam for patients with acute cardiogenic pulmonary edema and hypoxemia during the treatment of non-invasive ventilation ( NIV ) . METHODS The intensive care unit ( ICU ) patients treated in our hospital between March 2008 and August 2011 who had acute pulmonary edema and hyoxemia in NIV failure due to patient refusal to continue the NIV sessions ( due to discomfort ) were enrolled in this study . The patients were divided into two groups by the r and om numerical table method . They were treated with either midazolam ( 29 cases ) or dexmedetomidine ( 33 cases ) . The patients were se date d ( Ramsay scale 2 - 3 ) by a continuous perfusion of midazolam or dexmedetomidine during the NIV session . Cardiorespiratory and ventilatory parameters , the results of the blood gas analysis , and adverse events were prospect ively recorded . The main outcome measure was the percentage of endotracheal intubation during NIV . Secondary endpoints included the duration of non-invasive mechanical ventilation , length of ICU stay , and adverse events . RESULTS In both groups of patients , the expected sedative scores were obtained . The cardiorespiratory symptoms and signs ( oxygenation index , pH value , and respiratory rate ) were significantly improved in both groups . In the dexmedetomidine-treated group , the patients had a further decreased percentage of failure of NIV requiring endotracheal intubation ( ETI ) and a more prolonged mean time to ETI ( p=0.042 , p=0.024 ) . Furthermore , when compared with the group treated with midazolam , the overall duration of mechanical ventilation and the duration of ICU hospitalization in the group treated with dexmedetomidine were markedly decreased , and weaning from mechanical ventilation was easier ( p=0.010 , p=0.042 ) . Despite the fact that more dexmedetomidine-treated patients developed bradycardia ( 18.2 % vs. 0 , p=0.016 ) , no patients required an intervention or interruption of study drug infusion . Conversely , the incidence of respiratory infections and vomiting was lower in the dexmedetomidine-treated patients ( p=0.026 , p=0.010 ) . CONCLUSION Dexmedetomidine led to a more desired level of awaking sedation , shortened the duration of mechanical ventilation and the length of the ICU stay , and further reduced the prevalence of nosocomial infection for NIV sedation in patients with acute cardiogenic pulmonary edema . It appears to provide several advantages and safe control compared with the γ-amino butyric acid ( GABA ) agonist midazolam Background : Commonly used sedatives/analgesics can increase the risk of postoperative complications , including delirium . This double-blinded study assessed the neurobehavioral , hemodynamic , and sedative characteristics of dexmedetomidine compared with morphine-based regimen after cardiac surgery at equivalent levels of sedation and analgesia . Methods : A total of 306 patients at least 60 yr old were r and omized to receive dexmedetomidine ( 0.1–0.7 & mgr;g · kg−1 · h−1 ) or morphine ( 10 - 70  &  mgr;g  · kg−1 · h−1 ) with open-label propofol titrated to a target Motor Activity Assessment Scale of 2–4 . Primary outcome was the prevalence of delirium measured daily via Confusion Assessment Method for intensive care . Secondary outcomes included ventilation time , additional sedation/analgesia , and hemodynamic and adverse effects . Results : Of all sedation assessment s , 75.2 % of dexmedetomidine and 79.6 % ( P = 0.516 ) of morphine treatment were in the target range . Delirium incidence was comparable between dexmedetomidine 13 ( 8.6 % ) and morphine 22 ( 15.0 % ) ( relative risk 0.571 , 95 % confidence interval [ CI ] 0.256–1.099 , P = 0.088 ) , however , dexmedetomidine-managed patients spent 3 fewer days ( 2 [ 1–7 ] versus 5 [ 2–12 ] ) in delirium ( 95 % CI 1.09–6.67 , P = 0.0317 ) . The incidence of delirium was significantly less in a small subgroup requiring intraaortic balloon pump and treated with dexmedetomidine ( 3 of 20 [ 15 % ] versus 9 of 25 [ 36 % ] ) ( relative risk 0.416 , 95 % CI 0.152–0.637 , P = 0.001 ) . Dexmedetomidine-treated patients were more likely to be extubated earlier ( relative risk 1.27 , 95 % CI 1.01–1.60 , P = 0.040 , log-rank P = 0.036 ) , experienced less systolic hypotension ( 23 % versus 38.1 % , P = 0.006 ) , required less norepinephrine ( P < 0.001 ) , but had more bradycardia ( 16.45 % versus 6.12 % , P = 0.006 ) than morphine treatment . Conclusion : Dexmedetomidine reduced the duration but not the incidence of delirium after cardiac surgery with effective analgesia/sedation , less hypotension , less vasopressor requirement , and more bradycardia versus morphine regimen Background : Postoperative delirium ( POD ) is a serious complication after cardiac surgery . Use of dexmedetomidine to prevent delirium is controversial . The authors hypothesized that dexmedetomidine sedation after cardiac surgery would reduce the incidence of POD . Methods : After institutional ethics review board approval , and informed consent , a single-blinded , prospect i ve , r and omized controlled trial was conducted in patients 60 yr or older undergoing cardiac surgery . Patients with a history of serious mental illness , delirium , and severe dementia were excluded . Upon admission to intensive care unit ( ICU ) , patients received either dexmedetomidine ( 0.4 & mgr;g/kg bolus followed by 0.2 to 0.7 & mgr;g kg−1 h−1 infusion ) or propofol ( 25 to 50 & mgr;g kg−1 min−1 infusion ) according to a computer-generated r and omization code in blocks of four . Assessment of delirium was performed with confusion assessment method for ICU or confusion assessment method after discharge from ICU at 12-h intervals during the 5 postoperative days . Primary outcome was the incidence of POD . Results : POD was present in 16 of 91 ( 17.5 % ) and 29 of 92 ( 31.5 % ) patients in dexmedetomidine and propofol groups , respectively ( odds ratio , 0.46 ; 95 % CI , 0.23 to 0.92 ; P = 0.028 ) . Median onset of POD was on postoperative day 2 ( 1 to 4 days ) versus 1 ( 1 to 4 days ) , P = 0.027 , and duration of POD 2 days ( 1 to 4 days ) versus 3 days ( 1 to 5 days ) , P = 0.04 , in dexmedetomidine and propofol groups , respectively . Conclusions : When compared with propofol , dexmedetomidine sedation reduced incidence , delayed onset , and shortened duration of POD  in elderly patients after cardiac surgery .  The absolute risk reduction for POD was 14 % , with a number needed to treat of 7.1 Context Volatile anaesthetics may have direct cardioprotective properties due to effects similar to ischaemic preconditioning and postconditioning . Clinical results in cardiac surgery patients are controversial and may be related to the timing of administration of anaesthetics intraoperatively . Objective We hypothesised that the cardioprotective effect of sevoflurane in coronary bypass graft surgical patients would be greater if administration during anaesthesia continued in the ICU for at least 4 h postoperatively until weaning from mechanical ventilation . Design Double-blind , double-dummy , prospect i ve , r and omised and controlled clinical trial . Setting In a single centre between June 2006 and June 2007 . Patients Seventy-five adult patients were assigned r and omly to receive anaesthesia and postoperative sedation either with propofol ( control , n = 37 ) or sevoflurane ( n = 36 ) . Interventions Myocardial biomarkers were measured before surgery , at the time of admission to the intensive care unit and at 6 , 24 , 48 and 72 h. The need for inotropic support , and lengths of stay in the intensive care unit and hospital were also recorded . Main outcome measures Elevation of myocardial biomarkers was the primary endpoint . The secondary endpoints were haemodynamic events and lengths of stay in the intensive care unit and hospital . Results Necrosis biomarkers increased significantly in the postoperative period in both groups with no significant differences at any time . Inotropic support was needed in 72.7 and 54.3 % of patients in the propofol and sevoflurane groups , respectively ( P = 0.086 ) . There were no significant differences in haemodynamic variables , incidence of arrhythmias , myocardial ischaemia or and lengths of stay in the ICU and hospital between the two groups . Conclusion In patients undergoing coronary bypass graft surgery , continuous administration of sevoflurane as a sedative in the ICU for at least 4 h postoperatively did not yield significant improvements in the extent and time course of myocardial damage biomarkers compared to propofol Objective : To compare duration of mechanical ventilation for patients r and omized to receive lorazepam by intermittent bolus administration vs. continuous infusions of propofol using protocol s that include scheduled daily interruption of sedation . Design : A r and omized open-label trial enrolling patients from October 2001 to March 2004 . Setting : Medical intensive care units of two tertiary care medical centers . Patients : Adult patients expected to require mechanical ventilation for > 48 hrs and who required ≥10 mg of lorazepam or a continuous infusion of a sedative to achieve adequate sedation . Interventions : Patients were r and omized to receive lorazepam by intermittent bolus administration or propofol by continuous infusion to maintain a Ramsay score of 2–3 . Sedation was interrupted on a daily basis for both groups . Measurements and Main Results : The primary outcome was median ventilator days . Secondary outcomes included 28-day ventilator-free survival , intensive care unit and hospital length of stay , and hospital mortality . Median ventilator days were significantly lower in the daily interruption propofol group compared with the intermittent bolus lorazepam group ( 5.8 vs. 8.4 , p = .04 ) . The difference was largest for hospital survivors ( 4.4 vs. 9.0 , p = .006 ) . There was a trend toward greater ventilator-free survival for patients in the daily interruption propofol group ( median 18.5 days for propofol vs. 10.2 for lorazepam , p = .06 ) . Hospital mortality was not different . Conclusions : For medical patients requiring > 48 hrs of mechanical ventilation , sedation with propofol results in significantly fewer ventilator days compared with intermittent lorazepam when sedatives are interrupted daily Objective To compare the safety and effectiveness of propofol ( 2,6-diisopropylphenol ) to midazolam for sedation of mechanically ventilated patients after coronary artery bypass grafting . Design Open , r and omized , prospect i ve trial . Setting Cardiothoracic intensive care unit ( ICU ) , Clevel and Clinic Foundation . Patients Eighty-four patients with normal or moderately impaired left ventricular function who underwent elective coronary artery bypass graft surgery under high-dose opioid anesthesia . Interventions Patients were r and omly selected to receive either propofol ( mean loading dose 0.24 mg/kg ; mean maintenance dose 0.76 mg/kg/hr ) or midazolam ( mean loading dose 0.012 mg/kg ; mean maintenance dose 0.018 mg/kg/hr ) . Infusion rates were titrated to keep patients comfortable , drowsy , and responsive to verbal stimulation . Study duration , 8 to 12 hrs ; infusions were started in the ICU when patients were awake and hemodynamically stable . Measurements and Main Results During therapy , both groups had lower mean arterial pressures and heart rates compared with baseline measurements ; however , the propofol group had significantly lower heart rates than the midazolam group during the first 2 hrs of infusion . The propofol group also had significantly lower blood pressure measurements 5 and 10 mins after the initial dose , although there was no difference during infusion . Baseline cardiac output was measured before starting the infusion , and measurements were repeated during continuous infusion at 4 , 8 , and 12 hrs . Cardiac output values were similar . Propofol maintenance infusions ranged from 3 to 30 μg/kg/min and midazolam infusions ranged from 0.1 to 0.7 μg/kg/min . At these infusion rates . both groups had adequate sedation , based on nurse and patient evaluations ; however , the propofol group used significantly lower total doses of sodium nitroprusside and supplemental opioids . Conclusions Both propofol and midazolam provided safe and effective sedation of coronary artery bypass graft patients recovering from high-dose opioid anesthesia . The reduced need for both antihypertensive medication and opioids seen in the propofol group may be advantageous . However , the hypotension seen after the initial bolus dose of propofol may be a concern . No difference between the two drugs could be demonstrated in time to extubation or ICU discharge , although it is probable that time to extubation was governed more by residual operative opioids than the study agents . ( Crit Care Med 1994 ; 22:1415–1423 PURPOSE OF THE STUDY To compare the efficacy of Dexmedetomidine and Propofol for short-term controlled sedation and analgesia in the early postoperative period after cardiac surgery . METHODS We performed open r and omized prospect i ve comparative study in 55 cardiovascular surgery patients . In the early postoperative period 28 patients received infusion of Dexmedetomidine  ( 0.2 - 0.7 microg/kg per hour ) while 27 patients --Propofol ( 0.3 - 2(system text of symbol ) ) . Analgesia was carried out with Ketoprofen 100 mg/12h and additional 20 mg of Trimeperidine in case of pain intensity > or = 3 points ( 5-level verbal pain score ) . Sedation and agitation level ( RASS scale ) , speed of awakening ( Aldrete score ) , duration of mechanical ventilation and stay in the ICU , need for additional opioid injections , type and frequency of side effects were evaluated . RESULTS We did n't find any significant differences in the duration of mechanical ventilation or rate of awakening after the end of infusion between the groups . Dexmedetomidine in the majority of cases result ed in mild or moderate sedation , Propofol -- in deeper level of sedation . Retro grade amnesia was reached significantly more often ( p < 0.05 ) in Dexmetomedine group . The daily dose of Trimeperidine in Propofol group was significantly higher ( 8 mg and 18 mg on average , p = 0.02 ) . Differences in side effects between the groups were noted -- bradycardia ( Dexmetomedine--10 ( 39 % ) , Propofol--3 ( 11 % ) , p = 0.004 ) arterial hypotension ( Dexmetomedine--9 ( 32 % ) , Propofol--15 ( 59 % ) , p = 0.002 ) and general malaise ( Dexmetomedine--2 ( 7 % ) , Propofol--6 ( 24 % ) , p = 0.001 ) . The length of stay in the ICU in Dexmetomedine group was significantly lower ( 1,1 days vs 2,6 days respectively , p = 0.006 ) . CONCLUSIONS To compare with Propofol Dexmetomedine induces less sedation level and more often provides retro grade amnesia with the same duration of mechanical ventilation and awakening rate . Dexmetomedine provides its own analgesic effect and shortens the length of patient 's stay in ICU . Bradycardia was noted more frequently in Dexmedetomidine while arterial hypotension , general malaise and delirium -- in Propofol group The alpha2 agonist dexmedetomidine is a new sedative and analgesic agent which is licensed in the USA for post-operative intensive care sedation . We compared dexmedetomidine with propofol in patients requiring sedation in intensive care . Twenty adult patients expected to require a minimum of 8 h artificial ventilation after surgery were r and omized to receive  sedation  with either dexmedetomidine or propofol infusions . Additional analgesia , if required , was provided by an alfentanil infusion . Depth of sedation was monitored using both the Ramsay sedation score ( RSS ) and the bispectral index ( BIS ) . Cardiovascular , respiratory , biochemical and haematological data were obtained . Patients ' perceptions of their intensive care stay were assessed using the Hewitt question naire . Sedation was equivalent in the two groups [ median ( interquartile range ) : RSS , propofol group 5 ( 4 - 5 ) , dexmedetomidine group 5 ( 4 - 6 ) ( P=0.68 ) ; BIS , propofol group 53 ( 41 - 64 ) , dexmedetomidine group 46 ( 36 - 58 ) ; P=0.32 ] , but the propofol group received three times more alfentanil compared with patients se date d with dexmedetomidine [ 2.5 ( 2.2 - 2.9 ) mg h(-1 ) versus 0.8 ( 0.65 - 1.2 ) mg h(-1 ) ( P=0.004 ) ] . No differences were found in arterial pressures between the groups , but heart rate was significantly lower in the dexmedetomidine group [ mean ( SD ) 75 ( 6 ) vs 90 ( 4 ) beats min(-1 ) ] . Extubation times were similar and rapid with the use of both sedative agents [ median ( range ) 28 ( 20 - 50 ) and 29 ( 15 - 50 ) min ( P=0.63 ) respectively for the propofol and dexmedetomidine groups ] . No adverse events related to the sedative infusions occurred in either group . Despite ventilation and intubation , patients se date d with dexmedetomidine could be easily roused to cooperate with procedures ( e.g. physiotherapy , radiology ) without showing irritation . From the clinician 's and patient 's perspectives , dexmedetomidine is a safe and acceptable sedative agent for those requiring intensive care . The rate pressure product is reduced in patients receiving dexmedetomidine , which may protect against myocardial ischaemia . Dexmedetomidine reduces the requirement for opioid analgesia CONTEXT Long-term sedation with midazolam or propofol in intensive care units ( ICUs ) has serious adverse effects . Dexmedetomidine , an α(2)-agonist available for ICU sedation , may reduce the duration of mechanical ventilation and enhance patient comfort . OBJECTIVE To determine the efficacy of dexmedetomidine vs midazolam or propofol ( preferred usual care ) in maintaining sedation ; reducing duration of mechanical ventilation ; and improving patients ' interaction with nursing care . DESIGN , SETTING , AND PATIENTS Two phase 3 multicenter , r and omized , double-blind trials carried out from 2007 to 2010 . The MIDEX trial compared midazolam with dexmedetomidine in ICUs of 44 centers in 9 European countries ; the PRODEX trial compared propofol with dexmedetomidine in 31 centers in 6 European countries and 2 centers in Russia . Included were adult ICU patients receiving mechanical ventilation who needed light to moderate sedation for more than 24 hours ( midazolam , n = 251 , vs dexmedetomidine , n = 249 ; propofol , n = 247 , vs dexmedetomidine , n = 251 ) . INTERVENTIONS Sedation with dexmedetomidine , midazolam , or propofol ; daily sedation stops ; and spontaneous breathing trials . MAIN OUTCOME MEASURES For each trial , we tested whether dexmedetomidine was noninferior to control with respect to proportion of time at target sedation level ( measured by Richmond Agitation-Sedation Scale ) and superior to control with respect to duration of mechanical ventilation . Secondary end points were patients ' ability to communicate pain ( measured using a visual analogue scale [ VAS ] ) and length of ICU stay . Time at target sedation was analyzed in per- protocol population ( midazolam , n = 233 , vs dexmedetomidine , n = 227 ; propofol , n = 214 , vs dexmedetomidine , n = 223 ) .  RESULTS Dexmedetomidine/midazolam ratio in time at target sedation was 1.07 ( 95 % CI , 0.97 - 1.18 ) and dexmedetomidine/propofol , 1.00 ( 95 % CI , 0.92 - 1.08 ) . Median duration of mechanical ventilation appeared shorter with dexmedetomidine ( 123 hours [ IQR , 67 - 337 ] ) vs midazolam ( 164 hours [ IQR , 92 - 380 ] ; P = .03 ) but not with dexmedetomidine ( 97 hours [ IQR , 45 - 257 ] ) vs propofol ( 118 hours [ IQR , 48 - 327 ] ; P = .24 ) . Patients ' interaction ( measured using VAS ) was improved with dexmedetomidine ( estimated score difference vs midazolam , 19.7 [ 95 % CI , 15.2 - 24.2 ] ; P < .001 ; and vs propofol , 11.2 [ 95 % CI , 6.4 - 15.9 ] ; P < .001 ) . Length of ICU and hospital stay and mortality were similar . Dexmedetomidine vs midazolam patients had more hypotension ( 51/247 [ 20.6 % ] vs 29/250 [ 11.6 % ] ; P = .007 ) and bradycardia ( 35/247 [ 14.2 % ] vs 13/250 [ 5.2 % ] ; P < .001 ) . CONCLUSIONS Among ICU patients receiving prolonged mechanical ventilation , dexmedetomidine was not inferior to midazolam and propofol in maintaining light to moderate sedation . Dexmedetomidine reduced duration of mechanical ventilation compared with midazolam and improved patients ' ability to communicate pain compared with midazolam and propofol . More adverse effects were associated with dexmedetomidine . TRIAL REGISTRATION clinical trials.gov Identifiers : NCT00481312 , NCT00479661 Objective : To compare the efficacy , safety , and cost of midazolam and propofol in prolonged sedation of critically ill patients . Design : R and omized , prospect i ve study . Setting : General intensive care unit ( ICU ) in a 1100-bed teaching hospital . Patients : 67 critically ill , mechanically ventilated patients . Interventions : Patients were invasively monitored and mechanically ventilated . A loading dose [ midazolam 0.11 ± 0.02 ( SEM ) mg · kg−1 , propofol 1.3 ± 0.2 mg · kg−1 ] was administered , followed by continuous infusion , titrated to achieve a predetermined sedation score . Sedation was continued as long as clinical ly indicated . Measurements and results : Mean duration of sedation was 141 and 99 h ( NS ) for midazolam and propofol , respectively , at mean hourly doses of 0.070 ± 0.003 mg · kg−1 midazolam and 1.80 ± 0.08 mg · kg−1 propofol . Overall , 68 % of propofol patients versus 31 % of midazolam ( p<0.001 ) patients had a > 20 % decrease in systolic blood pressure after the loading dose , and 26 versus 45 % ( p<0.01 ) showed a 25 % decrease in spontaneous minute volume . Propofol required more daily dose adjustments ( 2.1 ± 0.1 vs 1.4 ± 0.1 , p<0.001 ) . Nurserated quality of sedation with midazolam was higher ( 8.2 ± 0.1 vs 7.3 ± 0.1 on a 10-cm visual analog scale , p<0.001 ) . Resumption of spontaneous respiration was equally rapid . Recovery was faster after propofol ( p<0.02 ) , albeit with a higher degree of agitation . Amnesia was evident in all midazolam patients but in only a third of propofol patients . The cost of propofol was 4–5 times higher . Conclusions : Both drugs afforded reliable , safe , and controllable long-term sedation in ICU patients  and rapid weaning from mechanical ventilation . Midazolam depressed respiration , allowed better maintenance of sedation , and yielded complete amnesia at a lower cost , while propofol caused more cardiovascular depression during induction Delirium and transient neurologic dysfunctions ( TND ) often complicate the postoperative course after surgery for acute type-A aortic dissection ( AAD ) . We evaluated the role of clonidine on neurological outcome and respiratory function in 30 consecutive patients undergoing surgery for AAD . Patients were prospect ively r and omized to receive either clonidine ( 0.5 microg/kg bolus , followed by continuous infusion at 1 - 2 microg/kg/h ) or placebo ( NaCl 0.9 % ) in on starting and throughout the weaning period from the mechanical ventilation . Incidence of delirium and TND , Delirium Detection Score ( DDS ) , weaning parameters [ respiratory rate to tidal volume ratio - f/VT ; pressure-frequency product ( PFP ) ; partial pressure of arterial oxygen to fractional inspired oxygen concentration ( PaO(2)/FiO(2 ) ) ; partial pressure of carbon dioxide ( PaCO(2 ) ) ] , weaning duration and intensive care unit ( ICU ) length of stay were recorded . The two groups were similar for preoperative and operative variables and also for the incidence of postoperative complications . DDS was lower in the clonidine group ( P<0.001 ) . Patients weaned with clonidine showed lower f/VT and PFP , higher PaO(2)/FiO(2 ) and PaCO(2 ) , lower DDS , weaning period and the related ICU length of stay ( P<0.001 ) . This was further confirmed in patients developing delirium/TND . Intravenous clonidine after surgery for AAD reduces the severity of delirium , improves the respiratory function , shortens the weaning duration and the ICU length of stay Abstract Objectives . Intravenous sedation in the intensive care unit ( ICU ) may contribute to altered consciousness and prolonged mechanical ventilation . We tested the hypothesis that replacing intravenous propofol with inhaled sevoflurane for sedation after cardiac surgery would lead to shorter wake-up times , quicker patient cooperation , and less delusional memories . Design . Following coronary artery bypass surgery with cardiopulmonary bypass , 100 patients were r and omized to sedation with sevoflurane via the anesthetic conserving device or propofol .  Study drugs were administered for a minimum of 2 hours until criteria for extubation were met . Primary endpoints were time from drug stop to extubation and to adequate verbal response . Secondary endpoints were adverse recovery events , memories reported in the ICU Memory Tool test , and ICU/hospital stay . Results . Median time from drug stop to extubation ( interquartile range/total range ) was shorter after sevoflurane compared to propofol sedation ; 10 ( 10/100 ) minutes versus 25 ( 21/240 ) minutes ( p < 0.001 ) . Time from extubation to adequate verbal response was shorter ( p = 0.036 ) . No differences were found in secondary endpoints . Conclusions . Sevoflurane sedation after cardiac surgery leads to shorter wake-up times and quicker cooperation compared to propofol . No differences were seen in ICU-stay , adverse memories or recovery events in our short-term sedation OBJECTIVES To evaluate and compare the clinical efficacy , impact on hemodynamics , safety profiles , and cost of combined administration of propofol and midazolam ( synergistic sedation ) vs. midazolam and propofol administered as sole agents , for sedation of mechanically ventilated patients after coronary artery bypass grafting . DESIGN Prospect i ve , controlled , r and omized , double-blind clinical trial . SETTING Intensive care unit of SCIAS-Hospital de Barcelona . PATIENTS Seventy-five mechanically ventilated patients who underwent coronary artery bypass graft surgery under low-dose opioid anesthesia .  INTERVENTIONS According to the double-blind method , patients were r and omly assigned to receive propofol ( n = 25 ) , midazolam ( n = 25 ) , or propofol combined with midazolam ( n = 25 ) . Infusion rates were adjusted to stay between 8 and 11 points on Glasgow Coma Score modified by Cook and Palma . MEASUREMENTS AND MAIN RESULTS Mean + /- SD duration of sedation was 14.4 + /- 1.5 hrs , 14.1 + /- 1.1 hrs , and 14.7 + /- 1.9 hrs for the propofol , midazolam , and synergistic groups , respectively . The induction dose was 0.55 + /- 0.05 mg/kg for propofol as sole agent , 0.05 + /- 0.01 mg/kg for midazolam as sole agent , and 0.22 + /- 0.03 mg/kg for propofol administered in combination with 0.02 + /- 0.00 mg/kg of midazolam ( p = .001 ) . The maintenance dose was 1.20 + /- 0.03 mg/kg/hr for propofol as sole agent , 0.08 + /- 0.01 mg/kg/hr for midazolam as sole agent , and 0.50 + /- 0.09 mg/kg/hr for propofol administered in combination with 0.03 + /- 0.01 mg/kg/hr of midazolam ( p < .001 ) . All sedative regimens achieved similar efficacy in percentage of hours of adequate sedation ( 93 % for propofol , 88 % for midazolam , and 90 % for the synergistic group , respectively ) . After induction , both propofol and midazolam groups had significant decreases in systolic blood pressure , diastolic blood pressure , left atrial pressure , and heart rate . Patients in the synergistic group had significant bradycardia throughout the study , without impairment in other hemodynamic parameters . Patients se date d with propofol or synergistic regimen awoke sooner and could be extubated before those patients se date d with midazolam ( 0.9 + /- 0.3 hrs and 1.2 + /- 0.6 hrs vs. 2.3 + /- 0.8 hrs , respectively , p = .01 ) . Synergistic sedation produced cost savings of 28 % with respect to midazolam and 68 % with respect to propofol . CONCLUSIONS In the study conditions , the new synergistic treatment with propofol and midazolam administered together is an effective and safe alternative for sedation , with some advantages over the conventional regimen with propofol or midazolam administered as sole agents , such as absence of hemodynamic impairment , > 68 % reduction in maintenance dose , and lower pharmaceutical cost OBJECTIVES To evaluate and compare the clinical efficacy , impact on hemodynamic and oxygen transport variables , safety profiles , and cost efficiency of sedation and anxiolysis with lorazepam vs. continuous infusion of midazolam in critically ill , intensive care unit patients . DESIGN Multicenter , prospect i ve , r and omized , open-label study . SETTING Teaching hospitals . PATIENTS Ninety-five critically ill , mechanically ventilated patients with fiberoptic pulmonary artery catheters in place were r and omly assigned to receive short-term ( 8 hrs ) sedation with either intermittent intravenous injection lorazepam ( group A , n = 50 ) or continuous intravenous infusion midazolam ( group B , n = 45 ) titrated to clinical response . MEASUREMENTS AND MAIN RESULTS The severity of illness , demographic characteristics , levels of anxiety and agitation , hemodynamic parameters , oxygen transport variables , quality of sedation , nursing acceptance , and laboratory chemistries reflecting drug safety were recorded . There were no significant differences with regard to demographic data , hemodynamic and oxygen transport variables , or levels of anxiety/agitation between the two groups at baseline , 5 mins , 30 mins , and 4 and 8 hrs after administration of sedation . There were no significant differences in the quality of sedation or anxiolysis . Midazolam-treated patients used significantly larger amounts of drug for similar levels of sedation and anxiolysis ( 14.4 + /- 1.2 mg/8 hrs vs. 1.6 + /- 0.1 mg/8 hrs , p = .001 ) . Both drugs were safely administered and patient and nurse satisfaction was similar . CONCLUSIONS Sedation and anxiolysis with lorazepam and midazolam in critically ill patients is safe and clinical ly effective . Hemodynamic and oxygen transport variables are similarly affected by both drugs . The dose of midazolam required for sedation is much larger than the dose of lorazepam required for sedation , and midazolam is therefore less cost-efficient OBJECTIVE To compare the effectiveness of sedation , the time required for weaning , and the costs of prolonged sedation of critically ill mechanically ventilated patients with midazolam and propofol .  DESIGN Open-label , r and omized , prospect i ve , phase IV clinical trial . SETTING Medical and surgical intensive care unit ( ICU ) in a community hospital . PATIENTS All ICU admissions ( medical , surgical and trauma ) requiring mechanical ventilation for > 24 hrs . A total of 108 patients were included in the study . INTERVENTIONS Patients were r and omized to receive midazolam or propofol .  The dose range allowed for each drug was 0.1 to 0.5 mg/kg/hr for midazolam and 1 to 6 mg/kg/hr for propofol . The lowest dose that achieved an adequate patient-ventilator synchrony was infused . All patients received 0.5 mg/kg/24 hrs of morphine chloride . MEASUREMENTS AND MAIN RESULTS The level of sedation was quantified by the Ramsay scale every 2 hrs until weaning from mechanical ventilation was started . If sedation could not be achieved by infusing the highest dose of midazolam or propofol , the case was recorded as a therapeutic failure . In the propofol group , serum triglycerides were determined every 72 hrs . Concentrations of > 500 mg/dL were also recorded as a therapeutic failure . When the patient was ready for weaning according to defined criteria , sedation was interrupted abruptly and the time from interruption of sedation to the first T-bridge trial and to extubation was measured . Cost analysis was performed based on the cost of intensive care in our unit ( $ 54/hr ) . In the midazolam group ( n = 54 ) , 15 ( 27.8 % ) patients died ; 11 ( 20.4 % ) patients had therapeutic failure ; and 28 ( 51.8 % ) patients were subjected to a T-bridge trial . In the propofol group ( n = 54 ) , these proportions were 11 ( 20.4 % ) , 18 ( 33.4 % [ including seven due to inadequate sedation , and 11 due to hypertriglyceridemia ] ) , and 25 ( 46.2 % ) , respectively . None of these values was significantly different between the two groups . Duration of sedation was 141.7 + /- 89.4 ( SD ) hrs and 139.7 + /- 84.7 hrs ( p = NS ) , and cost ( US dollars ) attributed to sedation was $ 378 + /- 342 and $ 1,047 + /- 794 ( p = .0001 ) for the midazolam and propofol groups , respectively . In the midazolam group , time from discontinuation of the drug infusion to extubation was 97.9 + /- 54.6 hrs ( 48.9 + /- 47.2 hrs to the first disconnection , and 49.0 + /- 23.7 hrs to extubation ) . In the propofol group , time from discontinuation of the drug infusion to extubation was 34.8 + /- 29.4 hrs ( 4.0 + /- 3.9 hrs to the first disconnection , and 30.8 + /- 29.2 hrs to extubation ) . The difference between the two groups in the weaning time was 63.1 + /- 12.5 ( SEM ) hrs ( p < .0001 ) . Cost per patient in the midazolam group ( including ICU therapy and sedation with midazolam ) was $ 10,828 + /- 5,734 . Cost per patient in the propofol group was $ 9,466 + /- 5,820 , $ 1,362 less than in the midazolam group . CONCLUSIONS In our population of critically ill patients se date d with midazolam or propofol over prolonged periods , midazolam and propofol were equally effective as sedative agents . However , despite remarkable differences in the cost of sedation with these two agents , the economic profile is more favorable for propofol than for midazolam due to a shorter weaning time associated with propofol administration OBJECTIVE To evaluate the efficacy and safety of dexmedetomidine for post-operative elder patients on mechanical ventilation ( MV ) . METHODS For this r and omized controlled trial , 108 cases of post-operative patients on MV were enrolled and assigned into either dexmedetomidine group ( n = 54 ) or propofol group ( n = 54 ) for sedation . And propofol was used for rescue . The dose of sedation was regulated by Ramsay score for maintaining a sedative score of 3 - 4 . In both groups , fentanyl was provided intravenously continually for analgesia . The amount of fentanyl was adjusted according to the numerical rating scale ( NRS ) score for maintaining an analgesic score of 0 - 3 . The average Ramsay score , the frequency of propofol , the highest score of NRS , the total dosage of fentanyl and recovery time were compared . Additional outcomes included duration of mechanical ventilation and intensive care unit ( ICU ) length . And the incidence of delirium and cardiovascular adverse events were compared for two groups . RESULTS No significant inter-group difference existed in the effectiveness of sedation . Compare with propofol group , the highest score of NRS decreased ( 1.8 ± 1.12 vs 3.1 ± 1.24 , P < 0.05 ) , the total dosage of fentanyl significantly decreased ( 427.6 ± 14.1 vs 658.4 ± 27.3 µg , P < 0.05 ) and recovery time became significantly shortened ( 0.3 ± 0.02 h vs 1.1 ± 0.3 h , P < 0.05 ) in dexmedetomidine group . Median duration of mechanical ventilation  in dexmedetomidine group ( 21.0 h , 95%CI : 18.6 - 21.4 h ) was significantly shorter than that in propofol group ( 28.0 h , 95%CI : 25.6 - 30.4 h ) ( P < 0.05 ) . No inter-group differences existed in the ICU length of stay and the incidence of delirium . Two cases in dexmedetomidine  group developed bradycardia while hypotension occurred in two cases of propofol group . CONCLUSION Sedative effects of dexmedetomidine are safe and effective for post-operative elder patients on MV . And it offers a better efficacy of analgesia and shorter duration s of MV and recovery time . But dexmedetomidine had no significant influence on the ICU length of stay or the incidence of delirium OBJECTIVE To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft ( CABG ) surgery in the intensive care unit ( ICU ) . DESIGN R and omized , open label . SETTING Twenty-five centers in the United States and Canada . PARTICIPANTS Two hundred ninety-five adults undergoing CABG surgery . INTERVENTIONS At sternal closure , patients in group A received 1.0 microg/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 microg/kg/h to maintain a Ramsay sedation score > or =3 during assisted ventilation and > or = 2 after extubation . Patients could be given propofol for additional sedation if necessary ; group B patients received propofol-based care according to each investigator 's st and ard practice . MEASUREMENTS AND MAIN RESULTS Mean sedation levels were within target ranges in both groups . Mean times to weaning and extubation were similar , although fewer dexmedetomidine patients remained on the ventilator beyond 8 hours . Morphine use was significantly reduced in the dexmedetomidine group . Only 28 % of the dexmedetomidine patients required morphine for pain relief while ventilated versus 69 % of propofol-based patients ( p < 0.001 ) . Propofol patients required 4 times the mean dose of morphine while in the ICU . Mean blood pressure increased initially in both groups , then decreased to 3 mmHg below baseline in dexmedetomidine patients ; mean arterial pressure remained at 9 mmHg above baseline in propofol patients . No ventricular tachycardia occurred in the dexmedetomidine-se date d patients compared with 5 % of the propofol patients ( p = 0.007 ) . Respiratory rates and blood gases were similar . Fewer dexmedetomidine patients received beta-blockers ( p = 0.014 ) , antiemetics ( p = 0.015 ) , nonsteroidal anti-inflammatory drugs ( p < 0.001 ) , epinephrine ( p = 0.030 ) , or high-dose diuretics ( p < 0.001 ) . CONCLUSION Dexmedetomidine provided safe and effective sedation for post-CABG surgical patients and significantly reduced the use of analgesics , beta-blockers , antiemetics , epinephrine , and diuretics Objective : Delirium is common during critical illness and associated with adverse outcomes . We compared characteristics and outcomes of delirious and nondelirious patients enrolled in a multicenter trial comparing  protocol ized sedation with protocol ized sedation plus daily sedation interruption . Design : R and omized trial . Setting : Sixteen North American medical and surgical ICUs . Patients : Four hundred thirty critically ill , mechanically ventilated adults . Interventions : All patients had hourly titration of opioid and benzodiazepine infusions using a vali date d sedation scale . For patients in the interruption group , infusions were resumed , if indicated , at half of previous doses . Delirium screening occurred daily ; positive screening was defined as an Intensive Care Delirium Screening Checklist score of 4 or more at any time . Measurements and Main Results : Delirium was diagnosed in 226 of 420 assessed patients ( 53.8 % ) . Coma was identified in 32.7 % of delirious compared with 22.7 % of nondelirious patients ( p = 0.03 ) . The median time to onset of delirium was 3.5 days ( interquartile range , 2–7 ) , and the median duration of delirium was 2 days ( interquartile range , 1–4 ) . Delirious patients were more likely to be male ( 61.1 % vs 46.6 % ; p = 0.005 ) , have a surgical/trauma diagnosis ( 21.2 % vs 11.0 % ; p = 0.030 ) , and history of tobacco ( 31.5 % vs 16.2 % ; p = 0.002 ) or alcohol use ( 34.6 % vs 20.9 % ; p = 0.009 ) . Patients with positive delirium screening had longer duration of ventilation ( 13 vs 7 d ; p < 0.001 ) , ICU stay ( 12 vs 8 d ; p < 0.0001 ) , and hospital stay ( 24 vs 15 d ; p < 0.0001 ) . Delirious patients were more likely to be physically restrained ( 86.3 % vs 76.7 % ; p = 0.014 ) and undergo tracheostomy ( 34.6 % vs 15.5 % ; p < 0.0001 ) . Antecedent factors independently associated with delirium onset were restraint use ( hazard ratio , 1.87 ; 95 % CI , 1.33–2.63 ; p = 0.0003 ) , antipsychotic administration ( hazard ratio , 1.67 ; 95 % CI , 1.005–2.767 ; p = 0.047 ) , and midazolam dose ( hazard ratio , 0.998 ; 95 % CI , 0.997–1.0 ; p = 0.049 ) . There was no difference in delirium prevalence or duration between the interruption and control groups . Conclusion : In mechanically ventilated adults , delirium was common and associated with longer duration of ventilation and hospitalization . Physical restraint was most strongly associated with delirium Background Alpha2 ‐Adrenergic agonists decrease sympathetic tone with ensuing attenuation of neuroendocrine and hemodynamic responses to anesthesia and surgery . The effects of dexmedetomidine , a highly specific alpha2 ‐adrenergic agonist , on these responses have not been reported in patients undergoing coronary artery bypass grafting . Methods Eighty patients scheduled for elective coronary artery bypass grafting received , in a double‐blind manner , either a saline placebo or a dexmedetomidine infusion , initially 50 ng [ center dot ] kg‐1 [ center dot ] min‐1 for 30 min before induction of anesthesia with fentanyl , and then 7 ng [ center dot ] kg‐1 [ center dot ] min‐1 until the end of surgery . Filling pressures , blood pressure , and heart rate were controlled by intravenous fluid and by supplemental anesthetics and vasoactive drugs . Results Compared with placebo , dexmedetomidine  decreased plasma norepinephrine concentrations by 90 % , attenuated the increase of blood pressure during anesthesia ( 3 vs. 24 mmHg ) and surgery ( 2 vs. 14 mmHg ) , but increased slightly the need for intravenous fluid challenge ( 29 vs. 20 patients ) and induced more hypotension during cardiopulmonary bypass ( 9 vs. 0 patients ) . Dexmedetomidine decreased the incidence of intraoperative ( 2 vs. 13 patients ) and postoperative ( 5 vs. 16 patients ) tachycardia . Dexmedetomidine also decreased the need for additional doses of fentanyl ( 3.1 vs. 5.4 ) , the increments of enflurane ( 4.4 vs. 5.6 ) , the need for beta blockers ( 3 vs. 11 patients ) , and the incidence of fentanyl‐induced muscle rigidity ( 15 vs. 33 patients ) and postoperative shivering ( 13 vs. 23 patients ) . Conclusions Intraoperative intravenous infusion of dexmedetomidine to patients undergoing coronary artery revascularization decreased intraoperative sympathetic tone and attenuated hyperdynamic responses to anesthesia and surgery but increased the propensity toward hypotension OBJECTIVE To study sedative effect and safety of dexmedetomidine and midazolam for post-operative patients undergoing mechanical ventilation(MV ) in surgical intensive care unit(SICU ) . METHODS Two hundred cases of post-operative patients undergoing MV with tracheal intubation in SICU were enrolled and divided into two groups by r and om numerical table method . They were treated either with midazolam ( 98 cases ) or dexmedetomidine ( 102 cases ) . In both groups fentanyl was given intravenously continually for analgesia . The amount of fentanyl was adjusted according to Prince-Henry analgesic score to keep on 1 - 2 analgesic score ; the dose of sedation was regulated by Riker sedative and restless score ( SAS ) maintain 2 - 4 sedative score . During the course , parameters of the ventilator , electrocardiogram , heart rate(HR ) , blood pressure , respiratory rate , pulse oxygen saturation ( SpO(2 ) ) , blood gas analysis were observed and registered continuously . The amount of the drug , duration of MV , and incidence of side-effects such as hypotension , bradycardia , delirium , nausea , etc . were recorded in two groups . RESULTS In all the patients in two groups taking dexmedetomidine or midazolam expected sedative and analgesia scores were obtained . In the group with dexmedetomidine , the patients were aroused easier with adequate sedation , and when compared with the group with midazolam , dose of fentanyl ( μg × kg(-1) × h(-1 ) ) was significantly smaller ( 0.23±0.13 vs. 0.41±0.12 , P<0.01 ) , duration of MV ( hours ) was clearly shorter ( 7.20±6.29 vs. 12.44±8.96 , P<0.01 ) , the rates of hypotension ( 27.45 % vs. 11.22 % ) and bradycardia ( 24.51 % vs. 10.20 % ) were significantly higher ( both P<0.05 ) , the rate of delirium was clearly lower ( 3.92 % vs. 31.63 % , P<0.01 ) , the rate of nausea showed a slight decrease ( 9.80 % vs. 11.22 % , P>0.05 ) . The patients in the group with dexmedetomidine were divided into two subgroups of hypotension and non-hypotension . The quantity of blood loss during operation ( ml/kg ) , amount of fluid infusion during operation ( ml × kg(-1) × h(-1 ) ) , blood lactic acid concentration ( mmol/L ) on the day of surgical operation and the 1st day post-operative showed no significant difference between these subgroups ( quantity of blood loss on the day of surgical operation : 12.79±12.13 vs. 13.52±11.62 ; amount of fluid infusion during surgical operation : 11.91±4.59 vs. 13.09±7.05;blood lactic acid concentration on the day of operation : 1.88±1.07 vs. 1.71±0.87 , blood lactic acid concentration on the 1st day post-operative:1.43±0.98 vs. 1.37±0.79 , all P>0.05 ) . CONCLUSION Sedative effect of dexmedetomidine is satisfactory for patients undergoing MV after operation , with the property of easier arousal , lower delirium rate , and it helps to shorten the duration of MV with reduction the dosage of fentanyl by 50 % . However , it is necessary to enhance observation in order to prevent and control hypotension and bradycardia OBJECTIVE To compare the sedative effect and safety of dexmedetomidine and midazolam in the intensive care unit ( ICU ) patients undergoing ventilator bundle treatment . METHODS A prospect i ve single-blind r and omized controlled trial ( RCT ) was conducted . Ninety patients receiving ICU ventilator-assisted therapy and ventilator bundle treatments for more than 3 days in the First Department of Critical Care Medicine of the Second Hospital of Lanzhou University from January 2013 to December 2014 were enrolled . The patients were r and omly divided into two groups for sedative treatment . The patients in dexmedetomidine group ( n = 42 ) were given dexmedetomidine 0.2 - 0.7 μg x kg(-1 ) x h(-1 ) to achieve a goal of satisfactory sedation [ Richmond agitation-sedation scale ( RASS ) score 0 to - 2 during the day , and -1 to -3 at night ) . The patients in midazolam group ( n = 48 ) were given midazolam 2 - 3 mg intravenously first , and then 0.05 mg x kg(-1 ) x h(-1 ) for maintenance . The drug dose was adjusted according to RASS every 4 hours to maintain the appropriate sedation depth . The patients in both groups received continuous intravenous infusion of fentanyl for analgesia . Ventilator bundle treatments included the head of a bed up 30 degrees to 45 degrees , awaken and extubation appraisal , daily use of proton pump inhibitors for peptic ulcer prevention , prevention of deep vein thrombosis ( DVT ) , chlorhexidine mouth nursing , and removal of sputum by suction from subglottic area . When the patients in both groups obtained satisfactory target sedation , daily awakening was conducted , and spontaneous breathing test ( SBT ) was carried out to determine optional weaning time . When the condition was optimal , weaning was conducted , otherwise ventilator bundle treatments were continued . The systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , mean arterial pressure ( MAP ) , heart rate ( HR ) , respiratory frequency ( RR ) were monitored before and 15 , 30 , 60 , 120 , 180 minutes after the treatment , and at the moment of extubation and 30 minutes after extubation . The duration of mechanical ventilation , extubation time , length of ICU stay , and the incidence of adverse events were also recorded . RESULTS Both dexmedetomidine and midazolam could give rise to sedation with same score of analgesia in patients in both groups , and similar effect of sedation and analgesia could be achieved . Compared with midazolam , dexmedetomidine could significantly reduce the duration of mechanical ventilation ( hours : 108.33 ± 21.96 vs. 119.85 ± 20.29 , t = -2.586 , P = 0.011 ) , earlier extubation time ( hours : 112.95 ± 22.20 vs. 128.58 ± 26.18 , = -3.031 , P = 0.003 ) , length of ICU stay ( hours : 149.21 ± 20.47 vs. 163.88 ± 33.59 , = -2.457 , P = 0.016 ) , the incidence of delirium [ 9.5 % ( 4/42 ) vs. 31.2 % ( 15/48 ) , χ2 = 6.349 , P = 0.012 ] , but it would elevate the incidence of severe hypotension [ 28.6 % ( 12/42 ) vs. 8.3 % ( 4/48 ) , χ2 = 6.277 , P = 0.012 ] and severe bradycardia [ 19.0 % ( 8/42 ) vs. 8.3 % ( 4/48 ) , χ2 = 2.225 , P = 0.136 ] . Both drugs could lower SBP , DBP , MAP , and HR , and the effect in dexmedetomidine group was more significant from 60 minutes after treatment [ SBP ( mmHg , 1 mmHg = 0.133 kPa ) : 113.12 ± 14.42 vs. 124.40 ± 15.79 , DBP ( mmHg ) : 69.02 ± 9.62 vs. 76.94 ± 10.41 , MAP ( mmHg ) : 83.76 ± 10.50 vs. 92.77 ± 11.87 , HR ( bpm ) : 79.19 ± 12.28 vs. 87.42 ± 17.77 , P < 0.05 or P < 0.01 ] . Both sedatives could significantly lower the rate of spontaneous breathing , and the effect of midazolam group was more significant from 60 minutes after treatment compared with dexmedetomidine group ( times/min : 18.27 ± 4.29 vs. 20.07 ± 4.11 , P < 0.05 ) . CONCLUSIONS The sedative effects of dexmedetomidine in the ICU patients treated with ventilator bundle treatment are satisfactory , and it can shorten the duration of mechanical ventilation , extubation time and length of ICU stay , reduce the incidence of delirium . However , monitoring should be strengthened in order to prevented and control the adverse effects such as severe hypotension and severe bradycardia IMPORTANCE Effective therapy has not been established for patients with agitated delirium receiving mechanical ventilation . OBJECTIVE To determine the effectiveness of dexmedetomidine when added to st and ard care in patients with agitated delirium receiving mechanical ventilation . DESIGN , SETTING , AND PARTICIPANTS The Dexmedetomidine to Lessen ICU Agitation ( DahLIA ) study was a double-blind , placebo-controlled , parallel-group r and omized clinical trial involving 74 adult patients in whom extubation was considered inappropriate because of the severity of agitation and delirium . The study was conducted at 15 intensive care units in Australia and New Zeal and from May 2011 until December 2013 . Patients with advanced dementia or traumatic brain injury were excluded . INTERVENTIONS Bedside nursing staff administered dexmedetomidine ( or placebo ) initially at a rate of 0.5 µg/kg/h and then titrated to rates between 0 and 1.5 µg/kg/h to achieve physician-prescribed sedation goals . The study drug or placebo was continued until no longer required or up to 7 days . All other care was at the discretion of the treating physician . MAIN OUTCOMES AND MEASURES Ventilator-free hours in the 7 days following r and omization . There were 21 reported secondary outcomes that were defined a priori . RESULTS Of the 74 r and omized patients ( median age , 57 years ; 18 [ 24 % ] women ) , 2 withdrew consent later and 1 was found to have been r and omized incorrectly , leaving 39 patients in the dexmedetomidine group and 32 patients in the placebo group for analysis . Dexmedetomidine  increased ventilator-free hours at 7 days compared with placebo ( median , 144.8 hours vs 127.5 hours , respectively ; median difference between groups , 17.0 hours [ 95 % CI , 4.0 to 33.2 hours ] ; P = .01 ) . Among the 21 a priori secondary outcomes , none were significantly worse with dexmedetomidine , and several showed statistically significant benefit , including reduced time to extubation ( median , 21.9 hours vs 44.3 hours with placebo ; median difference between groups , 19.5 hours [ 95 % CI , 5.3 to 31.1 hours ] ; P < .001 ) and accelerated resolution of delirium ( median , 23.3 hours vs 40.0 hours ; median difference between groups , 16.0 hours [ 95 % CI , 3.0 to 28.0 hours ] ; P = .01 ) . Using hierarchical Cox modeling to adjust for imbalanced baseline characteristics , allocation to dexmedetomidine was significantly associated with earlier extubation ( hazard ratio , 0.47 [ 95 % CI , 0.27 - 0.82 ] ; P = .007 ) . CONCLUSIONS AND RELEVANCE Among patients with agitated delirium receiving mechanical ventilation in the intensive care unit , the addition of dexmedetomidine to st and ard care compared with st and ard care alone ( placebo ) result ed in more ventilator-free hours at 7 days . The findings support the use of dexmedetomidine in patients such as these . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01151865
Sedatives are commonly used for mechanically ventilated patients in intensive care units ( ICU ) .
However , a variety of sedatives are available and their efficacy and safety have been compared in numerous trials with inconsistent results .
To resolve uncertainties regarding usefulness of these sedatives , we performed a systematic review and network meta- analysis .