The use of midazolam versus propofol for short-term sedation following coronary artery bypass grafting

Abstract

Midazolam and propofol were compared in an open randomized study for postoperative sedation during 12 h of mechanical ventilation in 40 patients following coronary artery bypass grafting. After an intravenous loading dose of midazolam (50 micrograms.kg-1) or propofol (500 micrograms.kg-1), a titrated continuous infusion was administered of midazolam (mean dose 38.1 micrograms.kg-1.h-1 (SEM 2.6)) or propofol (mean dose 909 micrograms.kg-1.h-1 (SEM 100)) together with a narcotic analgesic infusion. During mechanical ventilation midazolam and propofol produced a similar quality of sedation, but recovery (midazolam 66 min (SEM 16); propofol 24 min (SEM 7)) and weaning from the ventilator (midazolam 243 min (SEM 44); propofol 154 min (SEM 33)) where faster with propofol. In the 2 groups administration of an intravenous loading dose caused a significant decrease in mean arterial pressure but hemodynamic tolerance during maintenance infusion was good.

Propofol increases preload dependency in septic shock patients

“…This result is particularly important to emphasize in patients with septic shock because no further decrease in tissue oxygen delivery occurs after infusion. A previous study has shown that propofol or midazolam infusion for sedation preserved the hemodynamics in critically ill patients after coronary artery bypass grafting [26]. Therefore, one might expect that propofol or midazolam could be used safely in patients' septic shock, which may already present with cardiac injury because such treatment may result in good hemodynamic tolerance.…”

Propofol or midazolam for short-term alterations in sedation

“…Although most studies have shown little difference between propofol or midazolam as far as cardiovascular changes are concerned, 3,5,6 one study has suggested that there may be a greater hypotensive effect associated with the use of propofol than with midazolam. 12 The lack of difference in these cardiovascular variables between the two groups in our study confirms the majority of earlier studies showing no difference between propofol and midazolam.…”

Evaluation of two processed EEG analyzers for assessment of sedation after coronary artery bypass grafting

“…Conscious sedation has been used in many trials during the immediate postoperative period after cardiac surgery and is mostly defined as Ramsay score of 2±4 [15,16,17,18]. Open eyes (Ramsay score 2) disturb the processed EEG, thus a Ramsay score of 4 may be best for testing the efficacy of conscious sedation.…”