• Southern medical journal · May 2004

    Randomized Controlled Trial Comparative Study Clinical Trial

    Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam.

    • Joseph D Tobias and John W Berkenbosch.
    • Division of Pediatric Critical Care/Pediatric Anesthesiology, Department of Anesthesiology, University of Missouri, Columbia, MO 65212, USA. tobiasj@health.missouri.edu
    • South. Med. J. 2004 May 1;97(5):451-5.

    BackgroundWe sought to compare the efficacy of midazolam versus dexmedetomidine for sedation during mechanical ventilation in infants and children.MethodsWe performed a prospective, randomized trial in a pediatric intensive care unit in a tertiary care center. Infants and children requiring mechanical ventilation underwent a continuous infusion of either midazolam (starting dose of 0.1 mg/kg/h) or dexmedetomidine (starting dose of either 0.25 or 0.5 microg/kg/h) with intermittent morphine, as needed. The efficacy of sedation was assessed using the Ramsay sedation scale, pediatric intensive care unit sedation score, and the tracheal suctioning score as well as bispectral monitoring.ResultsThere were 10 patients in each group. Sedation as assessed by the clinical sedation scores and the bispectral index was equivalent in the 3 groups. There were 36 morphine boluses administered to the midazolam group versus 29 and 20 morphine boluses administered respectively to the 0.25 and 0.5 microg/kg/h dexmedetomidine groups (P = 0.02 for midazolam versus 0.5 microg/kg/h dexmedetomidine). Total morphine use (mg/kg/24 h) was 0.74 +/- 0.5, 0.55 +/- 0.38, and 0.28 +/- 0.12 in the midazolam and the two dexmedetomidine groups respectively (P = not significant for midazolam versus 0.25 dexmedetomidine, P = 0.01 for midazolam versus 0.5 dexmedetomidine). In the two dexmedetomidine groups, 5 of 6 patients who at some point had a Ramsay score of 1 were less than 12 months of age while only 1 was more than 12 months of age (P < 0.05).ConclusionsAt a dose of 0.25 microg/kg/h, dexmedetomidine was approximately equivalent to midazolam at 0.22 mg/kg/h. At 0.5 microg/kg/h, dexmedetomidine provided more effective sedation as demonstrated by the need for fewer bolus doses of morphine, a decrease in the 24-hour requirements for supplemental morphine, as well as a decrease in the total number of assessment points with a Ramsay score of 1 (inadequate sedation) and the number of patients who had a Ramsay score of 1.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.