Sedation And Analgesia After Cardiac Surgery: Comparison Of Dexmedetomidine, Midazolam /Fentanyl And Midazolam/Dexketoprofen Trometamol

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Postoperative sedation and analgesia after cardiac surgery (n=75). Intervention: Dexmedetomidine vs. Midazolam/Fentanyl and Midazolam/Dexketoprofen Trometamol. Primary outcome: Ramsay Sedation Scale (RSS) scores at 2 and 4 hours postoperatively (p=0.001).

Q: What does this research mean for the field?

Dexmedetomidine provides effective sedation without respiratory depression, resulting in lower Ramsay Sedation Scale scores compared to midazolam/fentanyl and midazolam/dexketoprofen trometamol after cardiac surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sezer Karabulut; Zeliha Tuncel; Türkan Kudsioğlu; Filiz Coşkun; Nihan Yapıcı; Yasemin Altuntaş; Fatma Ukil; Hakan Nuraç; Mesut Öterkuş; Zuhal Aykaç

doi:10.5222/gkdad.2014.091

January 1, 2014Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care SocietyOpen Access

Sedation And Analgesia After Cardiac Surgery: Comparison Of Dexmedetomidine, Midazolam /Fentanyl And Midazolam/Dexketoprofen Trometamol

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Key result

Dexmedetomidine provided effective sedation without respiratory depression, resulting in lower Ramsay Sedation Scale scores compared to midazolam/fentanyl and midazolam/dexketoprofen.

Why the study?

The optimal postoperative analgesia and sedation method after cardiac surgery remains to be determined by comparing dexmedetomidine, midazolam/fentanyl, and midazolam/dexketoprofen trometamol.

Does dexmedetomidine improve postoperative sedation and analgesia compared to midazolam/fentanyl or midazolam/dexketoprofen trometamol in patients undergoing cardiac surgery?

Key Points

To compare the efficacy of dexmedetomidine, midazolam with fentanyl, and midazolam with dexketoprofen trometamol on postoperative pain, sedation depth, hemodynamics, and extubation time following cardiac surgery.
Conducted a comparative clinical study involving 75 cardiac surgery patients divided into three parallel cohorts (N=25 per group).
Administered midazolam (0.03 mg/kg/h) plus dexketoprofen trometamol (25–50 mg) in Group I, midazolam (0.03 mg/kg/h) plus fentanyl (2 mcg/kg/h) in Group II, and dexmedetomidine infusion (0.3–0.5 mcg/kg/h) in Group III.
Assessed pain via Visual Analog Scale (VAS) and sedation depth via Ramsay Sedation Scale (RSS), alongside tracking extubation duration, ICU stay, and total hospital stay.
Extubation times, duration of ICU stay, and overall hospital stay showed no statistically significant differences among the three groups.
Pain scores evaluated by VAS showed no significant differences at 30 minutes (T4) and 4 hours (T5) post-extubation across all cohorts.
Ramsay Sedation Scale scores differed significantly upon ICU arrival at T0 (p < 0.01), with Groups I and II displaying significantly higher sedation scores than Group III at intervals T2 and T3 (p = 0.001 and p = 0.001, respectively).

Study Design

Type

RCT (n=75)

Randomization

Randomized

Structured PICO

Does dexmedetomidine improve postoperative sedation and analgesia compared to midazolam/fentanyl or midazolam/dexketoprofen trometamol in patients undergoing cardiac surgery?

P

Population

75 patients aged 30-70 years undergoing open heart surgery, randomized to receive dexmedetomidine, midazolam/fentanyl, or midazolam/dexketoprofen trometamol for postoperative sedation.

I

Intervention

Dexmedetomidine HCL 0.3-0.5 mcg/kg/h infusion

C

Comparator

Midazolam 0.03 mg/kg/h + dexketoprofen trometamol 25-50 mg OR midazolam 0.03 mg/kg/h + fentanyl 2 mcg/kg/h

O

Outcome

Postoperative pain (Visual Analog Scale), sedation (Ramsay Sedation Scale), extubation time, and hemodynamicspatient reported

Main Result

p-value: p=0.001

Dexmedetomidine provides effective postoperative sedation and analgesia without respiratory depression in cardiac surgery patients, making it a suitable alternative to midazolam-based regimens.

Limitations

Need for further studies on midazolam/dexketoprofen combination

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Dexmedetomidine may provide effective post-cardiac surgery sedation without respiratory depression; leaves open confirmation in larger randomized trials.

Abstract

Amaç: Çalışmamızda kalp cerrahisi uygulanan hastalarda deksmedetomidin, midazolam / fentanil ve midazolam/deksketoprofen trometamolün postoperatif ağrı, sedasyon, ekstübasyon süresi ve hemodinami üzerine etkilerinin karşılaştırılarak erken postoperatif dönemde en etkin analjezi ve sedasyon yönteminin belirlenmesi hedeflenmiştir.Gereç ve Yöntem: Çalışmamıza kalp cerrahisi uygulanmış toplam 75 hasta alındı.Grup I: Deksketoprofen trometamol +Midazolam (n: 25), Grup II: Fentanil+ Midazolam (n: 25) ve Grup III: Deksmedetomidin (n: 25) olarak ayrıldı.Grup I'e midazolam 0.03 mg/kg/sa ve deksketoprofen trometamol 25-50 mg, Grup II'ye midazolam 0.03 mg/kg/sa ve fentanil 2 mcgr/kg/sa, Grup III'e deksmedetomidin HCL 0,3-0,5 mcg/kg/sa infüzyonu verildi.Hastaların kalp atım hızı (KAH), ortalama arteriyel kan basıncı (OAB), arteriyel kan gazı değerleri kaydedildi.Postoperatif ağrı değerlendirilmesi görsel (Visuel Analog Skalası-VAS), postoperatif sedasyon değerlendirilmesi Ramsay Sedasyon Skalası (RSS) ile yapıldı.Hastaların ekstübasyon ve postoperatif yoğun bakımda ve hastanede kalış süreleri kaydedildi.Bulgular: Grupların ekstübasyon süreleri, yoğun bakımda kalış ve hastanede yatış süreleri arasında anlamlı farklılık görülmedi.VAS değerlendirilmesinde ekstübasyondan 30 dk. sonra (T4) ve 4 saat sonra (T5) anlamlı farklılık bulunmadı.Postoperatif yoğun bakıma geliş döneminde (T0) değerlendirilen RSS skorları anlamlı farklılık gösterdi (p<0.01).Grup I ve Grup II T2 ve T3 RSS skorlarının Grup III'den anlamlı yüksek olduğu saptandı (p=0.001;p=0.001).Sonuç: Deksmedetomidinin kalp cerrahisi sonrası RSS skorundaki anlamlı fark ile postoperatif solunumu deprese edici etkisi olmadan sedasyon sağlaması, analjezik etkisi ile postoperatif sedasyon ve analjezide midazolam/fentanil ve midazolam/ deksketoprofen trometamole göre daha uygun bir ajan olduğu düşünmekteyiz.

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Cite This Study

Karabulut et al. (2014) conducted an RCT in Postoperative sedation and analgesia after cardiac surgery (n=75). Dexmedetomidine vs. Midazolam/Fentanyl and Midazolam/Dexketoprofen Trometamol was evaluated on Ramsay Sedation Scale (RSS) scores at 2 and 4 hours postoperatively (p=0.001). Dexmedetomidine provided effective sedation without respiratory depression, resulting in lower Ramsay Sedation Scale scores compared to midazolam/fentanyl and midazolam/dexketoprofen.

synapsesocial.com/papers/6ab5dbdde4139f8e74195406 https://doi.org/10.5222/gkdad.2014.091

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Sedation And Analgesia After Cardiac Surgery: Comparison Of Dexmedetomidine, Midazolam /Fentanyl And Midazolam/Dexketoprofen Trometamol

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sedation And Analgesia After Cardiac Surgery: Comparison Of Dexmedetomidine, Midazolam /Fentanyl And Midazolam/Dexketoprofen Trometamol

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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