Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients

Abstract

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:Prospective, randomized, controlled open-label study.Materials and Methods:A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly 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.

Clonidine for sedation in the critically ill: a systematic review and meta-analysis

“…The duration of mechanical ventilation was similar for patients receiving clonidine and those in the non-clonidine group (six studies, n  = 417 patients, MD 0.05 days, 95% CI -0.65 to 0.75, I 2  = 86%, moderate certainty) [24, 25, 27–30] (Fig. 2).…”

“…Four trials enrolled children [24–26, 29] and four enrolled adults [27, 28, 30, 31]. Clonidine was administered intravenously in six trials [24, 26–30] and via the enteral route in two trials [25, 31].…”

“…Most trials used clonidine as an adjunctive agent added to an established sedative regimen, generally consisting of a benzodiazepine and/or an opioid [24–26, 29–31]. A single trial used clonidine as a stand-alone agent, compared to dexmedetomidine [27]. …”

“…One did not blind patients or caregivers and excluded 21 of 180 patients post-randomization [28]. One was an open-label study, with associated risks of performance and detection bias [27]. Four did not describe allocation concealment [24, 26, 28, 31].…”

“…There was no difference in the duration of sedative infusions (three studies, 245 patients, MD -0.28 days, 95% CI = -0.91 to 0.34, I 2  = 82%, low certainty) [25–27] (Appendix 5), or total dose of benzodiazepines (four studies, 264 patients, SMD 0.02, 95% CI = -0.34 to 0.39, I 2  = 55%, moderate certainty) [25, 27, 29, 31] (Appendix 6) between the clonidine and non-clonidine groups. The total dose of narcotics was significantly reduced in the clonidine group compared to the non-clonidine group (four studies, 264 patients, standard mean difference (SMD) -0.26, 95% CI = -0.50 to -0.02, I 2  = 0%, moderate certainty) [25, 27, 29, 31] (Fig.…”