Canadian Journal of Anaesthesia

, Volume 44, Issue 6, pp 629–635

Propofol or midazolam for sedation and early extubation following cardiac surgery

  • Norman R. Searle
  • Sylvain Côté
  • Jean Taillefer
  • Michel Carrier
  • Line Gagnon
  • Micheline Roy
  • Daniel Lussier
Reports of Investigation

Abstract

Purpose

The purpose of this randomized, double-blind study was to evaluate the efficacy of midazolam and propofol for postoperative sedation and early extubation following cardiac surgery.

Methods

ASA physical status II-III patients scheduled to undergo elective first-time cardiac surgery with an ejection fraction > 45% were eligible. All patients received a standardized sufentanil/isoflurane anaesthesa. Dunng cardiopulmonary bypass 100 μg · kg−1· mm−1 propofol was substituted for isoflurane. Upon amval in the Intensive Care Unit (ICU). patients were randomized to either 10 μg · kg · min−1 propofol (n = 21) or 0.25 μg · kg · mm−1 midazolam (n = 20). Infusion rates were adjusted to maintain sedation within a predetermined range (Ramsay 2–4). The infuson was terminated after four hours. Patients were weaned from mechanical ventilation and their tracheas extubated when haemodynamic stability, haemostasis, normothermia and mental orientation were confirmed. Haemodynamic measurements, artenal blood gas tensions and pulmonary function tests were recorded at specified times.

Results

There were no differences between the two groups for the time spent at each level of sedation, number of infusion rate adjustments, amount of analgesic and vasoactive drugs, times to awakening and extubation. The costs of propofol were higher than those of midazolam. There were no differences in haemodynamic values, artenal blood gas tensions and pulmonary function.

Conclusion

We conclude that midazolam and propofol are safe and effective sedative agents permitting early extubation in this selected cardiac patient population but propofol costs were higher.

Résumé

But

Le but de cette étude randomisée, à double insu était d’évaluer l’efficacité du midazolam et du propofol pour sédation postopératoire en vue d’une extubation précoce postchirurgie cardiaque

Méthodologie

Tout patient ASA II-III admis pour une première chirurgie cardiaque élective ayant une fraction d’éjection > 45% était éligible. Tous les patients ont reçu une anesthésie standard à base de sufentanil/isoflurane. Durant la circulation extracorporelle, le propofol (100μg · kg−1· min−1) a été substitué à l’isoflurane. Dès l’arnvée aux soins intensifs, les patients furent randomisés soit au propofol (n = 21)à 10 μg · kg−1· mm−1 sort au midazolam (n = 20) 0.25 μg · kg−1· mm−1. Les débits de perfusion étaient ajustés pour maintenir un niveau de sédation prédéterminée (Ramsay 2–4). La perfusion était cessée après quatre heures. Les patients étaient sevrés de la ventilation mécanique et extubés lorsque la stabilité hémodynamique, l’hémostase, la normothermie et l’orientation mentale étaient confirmées. Des bilans hémodynamiques, gaz arténels et fonction pulmonaire furent enregistrés à des intervalles spécifiques.

Résultats

Il n’y avait pas de différence entre les groupes pour le temps occupé aux différents niveaux de sédation, d’ajustement de perfusion, le temps d’éveil et d’extubation. Le coût du propofol était plus élevé que celui du midazolam. La demande d’analgésique et l’utilisation d’agents vasoactifs étaient similaires. Aucune différence de fonction pulmonaire, gaz arténels et hémodynamique n’a été décelée.

Conclusion

Nous concluons que le midazolam et le propofol sont sécuritaires et efficaces comme agents de sédation permettant une extubation précoce pour ce groupe de patients cardiaques sélectionnés mais le coût du propofol est plus élevé.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Norman R. Searle
    • 1
    • 2
  • Sylvain Côté
    • 1
    • 2
  • Jean Taillefer
    • 1
    • 2
  • Michel Carrier
    • 1
    • 2
  • Line Gagnon
    • 1
    • 2
  • Micheline Roy
    • 1
    • 2
  • Daniel Lussier
    • 1
    • 2
  1. 1.Department of AnaesthesiaMontreal Heart InstituteMontrealCanada
  2. 2.Department of SurgeryMontreal Heart InstituteMontrealCanada

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