Sedative Effect of Dexmedetomidine versus Propofol on Postoperative Patients in ICU: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHUO Shuai , ZHENG Jianqiao ,  LlU Bin

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LlU Bin, Email: benbinliu@hotmail.com

Keywords：

Dexmedetomidine; Propofol; Intensive care unit (ICU); Sedation; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20120112

Video：

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Objective To evaluate the sedative and analgesic efficacy and adverse effect of dexmedetomidine versus propofol on the postoperative patients in intensive care unit (ICU).
Methods The relevant randomized controlled trials (RCTs) were searched in The Cochrane Library, MEDLINE, PubMed, SCI, SpringerLinker, ScinceDirect, CNKI, VIP, WanFang Data and CBM from the date of their establishment to November 2011. The quality of the included studies was evaluated after the data were extracted by two reviewers independently, and then the meta-analysis was performed by using RevMan 5.1.
Results Ten RCTs involoving 793 cases were included. The qualitative analysis results showed: within a certain range of dosage as dexmedetomidine: 0.2-2.5 μg/(kg·h), and propofol: 0.8-4 mg/(kg·h), dexmedetomidine was similar to propofol in sedative effect, but dexmedetomidine group needed smaller dosage of supplemental analgesics during the period of sedative therapy. The results of meta-analysis showed: the percentage of patients needing supplemental analgesics in dexmedetomidine group was less than that in propofol group during the period of sedative therapy (OR=0.24, 95%CI 0.08 to 0.68, P=0.008). Compared with the propofol group, the duration of ICU stay was significantly shorter in the dexmedetomidine group (WMD= –1.10, 95%CI –1.88 to –0.32, P=0.006), but the mechanical ventilated time was comparable between the two groups (WMD=0.89, 95%CI –1.15 to 2.93, P=0.39); the incidence of adverse effects had no significant difference between two groups (bradycardia: OR=3.57, 95%CI 0.86 to 14.75, P=0.08; hypotension: OR=1.00, 95%CI 0.30 to 3.32, P=1.00); respiratory depression seemed to be more frequently in propofol group, which however needed further study. Mortalities were similar in both groups after the sedative therapy (OR=1.03, 95%CI 0.54 to 1.99, P=0.92).
Conclusion Within an exact range of dosage, dexmedetomidine is comparable with propofol in sedative effect. Besides, it has analgesic effect, fewer adverse effects and fewer occurrences of respiratory depression, and it can save the extra dosage of analgesics and shorten ICU stay. Still, more larger-sample, multi-center RCTs are needed to provide more evidence to support this outcome.

Citation： ZHUO Shuai,ZHENG Jianqiao,LlU Bin. Sedative Effect of Dexmedetomidine versus Propofol on Postoperative Patients in ICU: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(6): 686-693. doi: 10.7507/1672-2531.20120112 Copy

1.	阮静, 皋源. 右旋美托咪啶在重症监护病室镇静镇痛中的应用. 医学综述, 2008, 14(12): 1898-1900.
2.	Claeys MA, Gepts E, Camu F, et al. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth, 1988, 60(1): 3-9.
3.	Aitkenhead AR, Pepperman ML, Willatts SM, et al. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet, 1989, 2(8665): 704-709.
4.	Barr J, Donner A. Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit. Crit Care Clin, 1995, 11(4): 827-847.
5.	Leino K, Mildh L, Lertola K, et al. Time course of changes in breathing pattern in morphine and oxycodone induced respiratory depression. Anaesthesia, 1999, 54(9): 835-840.
6.	Kamibayashi T, Maze M. Clinical uses of alpha 2-adrenergic agonists. Anesthesiology, 2000, 93(5): 1345-1350.
7.	Judith E, Tonny D, Jill A, et al. Sedative, amnestic,and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg, 2000, 90(3): 699-705.
8.	Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/ midazolam for long-term sedation during mechanical ventilation. Intensive Care Med, 2009, 35(2): 282-290.
9.	李民, 张利萍, 吴新民. 右美托咪啶在临床麻醉中应用的研究进展. 中国临床药理学杂志, 2007, 23(6): 466-470.
10.	Anger KE, Szumita PM, Baroletti SA, et al. Evaluation of Dexmedetomidine Versus Propofol-based Sedation Therapy in Mechanically Ventilated Cardiac Surgery Patients at a Tertiary Academic Medical Center. Crit Pathw Cardiol, 2010, 9(4): 221-226.
11.	Memis D, Kargi M, Sut N, et al. Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study. J Crit Care, 2009, 24(4): 603-608.
12.	Tasdogan M, Memis D, Sut N, et al. Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. J Clin Anesth, 2009, 21(6): 394-400.
13.	Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
14.	Kaneko T. Postoperative management of carotid endarterectomy with dexmedetomidine-a comparison with propofol. Masui, 2009, 57(6): 696-703.
15.	Memis D, Dökmeci D, Karamanlioğlu B, et al. A comparison of the effect on gastric emptying of propofol or dexmedetomidine in critically ill patients: preliminary study. Eur J Anaesthesiol, 2006, 23(8): 700-704.
16.	Corbett SM, Rebuck JA, Greene CM, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med, 2005, 33(5): 940-945.
17.	Elbaradie S, El Mahalawy FH, Solyman AH, et al. Dexmedetomidine vs. propofol for short-term sedation of postoperative mechanically ventilated patients. J Egypt Natl Cancer Inst, 2004, 16(3): 153-158.
18.	Herr DL, Sum-Ping ST, England M, et al. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth, 2003, 17(5): 576-584.
19.	Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit patient and clinician perceptions. Br J Anaesth, 2001, 87(5): 684-690.
20.	J.G Reves, Peter S.A. Glass, David A Lubarsky, et al. Miller’s Anesthesia: Intravenous Anesthetics. 7th Edition. Churchill Livingstone: elsevier, 2010.
21.	Correa-Sales C, Rabin BC, Maze M, et al. A hypnotic response to dexmedetomidine, an alpha 2 agonist, is mediated in the locus coeruleus in rats. Anesthesiology, 1992, 76(6): 948-952.
22.	Bekker A, Sturaitis MK. Dexmedetomidine for neurological surgery. Neurosurgery, 2005, 57(1): 1-10.
23.	Eisenach JC, De Kock M, Klimscha W, et al. Alpha 2 agonists and analgesia. Exp Opin Invest Drμgs, 1994, 3(10): 1005-1010.

1. 阮静, 皋源. 右旋美托咪啶在重症监护病室镇静镇痛中的应用. 医学综述, 2008, 14(12): 1898-1900.
2. Claeys MA, Gepts E, Camu F, et al. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth, 1988, 60(1): 3-9.
3. Aitkenhead AR, Pepperman ML, Willatts SM, et al. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet, 1989, 2(8665): 704-709.
4. Barr J, Donner A. Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit. Crit Care Clin, 1995, 11(4): 827-847.
5. Leino K, Mildh L, Lertola K, et al. Time course of changes in breathing pattern in morphine and oxycodone induced respiratory depression. Anaesthesia, 1999, 54(9): 835-840.
6. Kamibayashi T, Maze M. Clinical uses of alpha 2-adrenergic agonists. Anesthesiology, 2000, 93(5): 1345-1350.
7. Judith E, Tonny D, Jill A, et al. Sedative, amnestic,and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg, 2000, 90(3): 699-705.
8. Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/ midazolam for long-term sedation during mechanical ventilation. Intensive Care Med, 2009, 35(2): 282-290.
9. 李民, 张利萍, 吴新民. 右美托咪啶在临床麻醉中应用的研究进展. 中国临床药理学杂志, 2007, 23(6): 466-470.
10. Anger KE, Szumita PM, Baroletti SA, et al. Evaluation of Dexmedetomidine Versus Propofol-based Sedation Therapy in Mechanically Ventilated Cardiac Surgery Patients at a Tertiary Academic Medical Center. Crit Pathw Cardiol, 2010, 9(4): 221-226.
11. Memis D, Kargi M, Sut N, et al. Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study. J Crit Care, 2009, 24(4): 603-608.
12. Tasdogan M, Memis D, Sut N, et al. Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. J Clin Anesth, 2009, 21(6): 394-400.
13. Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
14. Kaneko T. Postoperative management of carotid endarterectomy with dexmedetomidine-a comparison with propofol. Masui, 2009, 57(6): 696-703.
15. Memis D, Dökmeci D, Karamanlioğlu B, et al. A comparison of the effect on gastric emptying of propofol or dexmedetomidine in critically ill patients: preliminary study. Eur J Anaesthesiol, 2006, 23(8): 700-704.
16. Corbett SM, Rebuck JA, Greene CM, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med, 2005, 33(5): 940-945.
17. Elbaradie S, El Mahalawy FH, Solyman AH, et al. Dexmedetomidine vs. propofol for short-term sedation of postoperative mechanically ventilated patients. J Egypt Natl Cancer Inst, 2004, 16(3): 153-158.
18. Herr DL, Sum-Ping ST, England M, et al. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth, 2003, 17(5): 576-584.
19. Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit patient and clinician perceptions. Br J Anaesth, 2001, 87(5): 684-690.
20. J.G Reves, Peter S.A. Glass, David A Lubarsky, et al. Miller’s Anesthesia: Intravenous Anesthetics. 7th Edition. Churchill Livingstone: elsevier, 2010.
21. Correa-Sales C, Rabin BC, Maze M, et al. A hypnotic response to dexmedetomidine, an alpha 2 agonist, is mediated in the locus coeruleus in rats. Anesthesiology, 1992, 76(6): 948-952.
22. Bekker A, Sturaitis MK. Dexmedetomidine for neurological surgery. Neurosurgery, 2005, 57(1): 1-10.
23. Eisenach JC, De Kock M, Klimscha W, et al. Alpha 2 agonists and analgesia. Exp Opin Invest Drμgs, 1994, 3(10): 1005-1010.

Chinese Journal of Evidence-Based Medicine

Sedative Effect of Dexmedetomidine versus Propofol on Postoperative Patients in ICU: A Systematic Review

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