Comparison of dexmedetomidine and propofol for sedation in patients with traumatic brain injury

Тарабрин, О.; Shcherbakov, S; Gavrychenko, D.; Mazurenko, G.

doi:10.1186/cc13606

Cited by 4 publications

(3 citation statements)

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“…Eleven full-text articles written in English (10) and Spanish (1) consisting of 2 randomized clinical trials and 7 observational studies were identified for inclusion in this review (Table 1). 16,20,[26][27][28][29][30][31][32][33][34]…”

Section: Resultsmentioning

confidence: 99%

“…HR was significantly lower at 8 hours in the dexmedetomidine (96.55 ± 8.47 bpm) or the combination (97.15 ± 13.98 bpm) groups compared with the propofol group (105.1 ± 10.94 bpm; P = 0.035); there were no significant differences in HR between groups at any other time points. Tarabrin et al 31 also measured MAP,SBP, DBP, and HR during a 3-hour dexmedetomidine infusion of 0.2 to 1.4 ug/kg/h and found no significant changes across any values during the infusion period. Similarly, Wang et al 26 observed no differences in SBP, DBP, MAP, or HR during a 70-minute dexmedetomidine infusion protocol, although MAP was maintained at baseline values with a continuous infusion of dopamine.…”

Section: Systemic Hemodynamicsmentioning

confidence: 99%

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Safety, Efficacy, and Clinical Outcomes of Dexmedetomidine for Sedation in Traumatic Brain Injury: A Scoping Review

Hatfield

Soto

Kelly-Hedrick

et al. 2023

Journal of Neurosurgical Anesthesiology

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Dexmedetomidine is a promising alternative sedative agent for moderate-severe Traumatic brain injury (TBI) patients. Although the data are limited, the posited benefits of dexmedetomidine in this population are a reduction in secondary brain injury compared with current standard sedative regimens. In this scoping review, we critically appraised the literature to examine the effects of dexmedetomidine in patients with moderate-severe TBI to examine the safety, efficacy, and cerebral and systemic physiological outcomes within this population. We sought to identify gaps in the literature and generate directions for future research. Two researchers and a librarian queried PubMed, Embase, Scopus, and APA Psy-cINFO databases. Of 920 studies imported for screening, 11 were identified for inclusion in the review. The primary outcomes in the included studied were cerebral physiology, systemic hemodynamics, sedation levels and delirium, and the presence of paroxysmal sympathetic hyperactivity. Dexmedetomidine dosing ranged from 0.2 to 1 ug/kg/h, with 3 studies using initial boluses of 0.8 to 1.0 ug/kg over 10 minutes. Dexmedetomidine used independently or as an adjunct seems to exhibit a similar hemodynamic safety profile compared with standard sedation regimens, albeit with transient episodes of bradycardia and hypotension, decrease episodes of agitation and may serve to alleviate symptoms of sympathetic hyperactivity. This scoping review suggests that dexmedetomidine is a safe and efficacious sedation strategy in patients with TBI.Given its rapid onset of action and anxiolytic properties, dexmedetomidine may serve as a feasible sedative for TBI patients.

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Section: Resultsmentioning

confidence: 99%

Section: Systemic Hemodynamicsmentioning

confidence: 99%

Safety, Efficacy, and Clinical Outcomes of Dexmedetomidine for Sedation in Traumatic Brain Injury: A Scoping Review

Hatfield

Soto

Kelly-Hedrick

et al. 2023

Journal of Neurosurgical Anesthesiology

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“…It has superior characteristics, and accidental overdose does not inhibit breathing, representing another advantage over other sedatives. 8,9 However, dexmedetomidine can decrease cardiac output. 10,11 Dexmedetomidine has sympatholytic effects that result in reduced blood pressure and heart rate via the activation of α2-adrenal receptors in the brain.…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical efficacy and safety between dexmedetomidine and propofol among patients undergoing gastrointestinal endoscopy: a meta-analysis

Liu

et al. 2021

J Int Med Res

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Objective To compare the clinical efficacy and safety of dexmedetomidine and propofol in patients who underwent gastrointestinal endoscopy. Methods Relevant studies comparing dexmedetomidine and propofol among patients who underwent gastrointestinal endoscopy were retrieved from databases such as PubMed, Embase, and Cochrane Library. Results Seven relevant studies (dexmedetomidine group, n = 238; propofol group, n = 239) met the inclusion criteria. There were no significant differences in the induction time (weighted mean difference [WMD] = 3.46, 95% confidence interval [CI] = −0.95–7.88, I2 = 99%) and recovery time (WMD = 2.74, 95% CI = −2.72–8.19, I2 = 98%). Subgroup analysis revealed no significant differences in the risks of hypotension (risk ratio [RR] = 0.56, 95% CI = 0.25–1.22) and nausea and vomiting (RR = 1.00, 95% CI = 0.46–2.22) between the drugs, whereas dexmedetomidine carried a lower risk of hypoxia (RR = 0.26, 95% CI = 0.11–0.63) and higher risk of bradycardia (RR = 3.01, 95% CI = 1.38–6.54). Conclusions Dexmedetomidine had similar efficacy and safety profiles as propofol in patients undergoing gastrointestinal endoscopy.

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A Systematic Review of Alpha-2 Agonists for Sedation in Mechanically Ventilated Neurocritical Care Patients

et al. 2017

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The use of sedative medications is commonplace in intensive care units (ICUs) and an invaluable clinical tool for the intensive care physician. Sedation for critically ill, mechanically ventilated patients provides an opportunity to reduce anxiety, discomfort as well as ventilator intolerance and dyssynchrony. Alpha-2 agonists in particular have become increasingly popular for use in the neurocritical care population due to their proposed effectiveness in facilitating examinations and procedures as well as reducing the need for adjunctive agents. However, there is a paucity of literature to assess the safety of their use in the neurocritically ill patients, a population that presents unique sensitivities and considerations for management of global and cerebral hemodynamics, agitation and facilitation of neurological assessments. This review assesses the safety and efficacy of alpha-2 agonists for non-procedural sedation in critically ill brain-injured patients on mechanical ventilation. In June 2016, we searched the EMBASE, MEDLINE and CENTRAL Cochrane Databases for randomized controlled trials, prospective and retrospective cohort studies examining neurocritically ill adult patients aged 18 years and older who are on mechanical ventilation and receiving alpha-2 agonists for non-procedural sedation. Primary outcomes of interest include mean arterial pressure (MAP), intracranial pressure (ICP), and cerebral perfusion pressure (CPP). Secondary outcomes include adverse events, duration of mechanical ventilation, 30-day mortality, ICU length of stay, incidence of delirium, and quality of sedation. We identified 17 studies for inclusion, all reporting on dexmedetomidine use, only 7 of which reported on our primary outcomes of interest. We found mixed results with regard to statistically significant changes in ICP, CPP, and MAP but did not find evidence of severe hemodynamic disturbances. However, the studies are notably limited by lack of reporting on sedative and hemodynamic adjuncts. Based on the limited available data, dexmedetomidine does not appear to result in severe, uncompensated hemodynamic disturbances (cerebral or systemic). The validation of an effective and safe agent with reporting of dosing strategy, sedation protocol use, co-interventions administered, and a priori defined adverse events is recommended.

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Comparison of dexmedetomidine and propofol for sedation in patients with traumatic brain injury

Cited by 4 publications

References 0 publications

Safety, Efficacy, and Clinical Outcomes of Dexmedetomidine for Sedation in Traumatic Brain Injury: A Scoping Review

Safety, Efficacy, and Clinical Outcomes of Dexmedetomidine for Sedation in Traumatic Brain Injury: A Scoping Review

Comparison of clinical efficacy and safety between dexmedetomidine and propofol among patients undergoing gastrointestinal endoscopy: a meta-analysis

A Systematic Review of Alpha-2 Agonists for Sedation in Mechanically Ventilated Neurocritical Care Patients

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