Key result
Propofol combined with low-dose midazolam achieved target sedation more often than propofol alone (91% vs 79%; P=0.0005) but prolonged weaning from mechanical ventilation.
Why the study?
Does propofol combined with low-dose midazolam improve sedation efficacy compared to propofol alone in male patients following elective coronary artery bypass grafting?
RCT (n=60)
Double-blind
Randomized
Does propofol combined with low-dose midazolam improve sedation efficacy compared to propofol alone in male patients following elective coronary artery bypass grafting?
Adding a continuous low-dose midazolam infusion to propofol for post-CABG sedation slightly improves sedation target achievement but at the cost of significantly prolonged mechanical ventilation weaning times.
May not justify adding low-dose midazolam to propofol post-CABG; extends RCT evidence on sedation-weaning trade-offs.
The aim was to compare the efficacy and side-effects of propofol combined with a constant, low dose of midazolam versus propofol alone for sedation. In a prospective, randomized and double-blinded study, 60 male patients scheduled for elective coronary bypass grafting were enrolled. Postoperatively, patients were stratified to receive either a continuous intravenous infusion of midazolam 1 mg/h or placebo. Target Ramsay sedation score was 3 to 5 corresponding to conscious sedation. An intention-to-treat design for propofol was performed to reach target sedation. Efficacy of sedation was statistically significantly higher in the group midazolam + intention-to-treat with propofol compared with the group placebo + intention-to-treat with propofol (91% vs 79%; P=0.0005). Nine of 27 patients in the midazolam group (33.4%) and nine of 26 patients in the placebo group (34.6%) needed no supplementary propofol. Weaning time from mechanical ventilation was longer in the midazolam group whether or not they required supplemental propofol when compared with placebo group (all: 432 +/- 218 min vs 319 +/- 223 min; P=0.04; supplementary propofol: 424 +/- 234 min vs 265 +/- 175 min; P=0.03). The cumulative number of patients remaining intubated was significantly higher in the group midazolam + propofol compared with the group placebo + propofol (P=0.03). In conclusion, target sedation is reached slightly more often by the co-administration of propofol and a low dose of midazolam, but weaning time from mechanical ventilation is prolonged by the co-administration of propofol and a low dose of midazolam.
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Walder et al. (2002) conducted an RCT in Sedation following Coronary Artery Bypass Grafting (n=60). Propofol and midazolam vs. Propofol alone (placebo plus propofol) was evaluated on Efficacy of sedation (target Ramsay sedation score 3 to 5) (p=0.0005). Propofol combined with low-dose midazolam achieved target sedation more often than propofol alone (91% vs 79%; P=0.0005) but prolonged weaning from mechanical ventilation.
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