Abstract | BACKGROUND: METHODS: A total of 306 patients at least 60 yr old were randomized to receive dexmedetomidine (0.1-0.7 microg x kg(-1) x h(-1)) or morphine (10-70 microg x kg(-1) x h(-1)) with open-label propofol titrated to a target Motor Activity Assessment Scale of 2-4. Primary outcome was the prevalence of delirium measured daily via Confusion Assessment Method for intensive care. Secondary outcomes included ventilation time, additional sedation/ analgesia, and hemodynamic and adverse effects. RESULTS: Of all sedation assessments, 75.2% of dexmedetomidine and 79.6% (P = 0.516) of morphine treatment were in the target range. Delirium incidence was comparable between dexmedetomidine 13 (8.6%) and morphine 22 (15.0%) (relative risk 0.571, 95% confidence interval [CI] 0.256-1.099, P = 0.088), however, dexmedetomidine-managed patients spent 3 fewer days (2 [1-7] versus 5 [2-12]) in delirium (95% CI 1.09-6.67, P = 0.0317). The incidence of delirium was significantly less in a small subgroup requiring intraaortic balloon pump and treated with dexmedetomidine (3 of 20 [15%] versus 9 of 25 [36%]) (relative risk 0.416, 95% CI 0.152-0.637, P = 0.001). Dexmedetomidine-treated patients were more likely to be extubated earlier (relative risk 1.27, 95% CI 1.01-1.60, P = 0.040, log-rank P = 0.036), experienced less systolic hypotension (23% versus 38.1%, P = 0.006), required less norepinephrine (P < 0.001), but had more bradycardia (16.45% versus 6.12%, P = 0.006) than morphine treatment. CONCLUSION:
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Authors | Yahya Shehabi, Peter Grant, Hugh Wolfenden, Naomi Hammond, Frances Bass, Michelle Campbell, Jack Chen |
Journal | Anesthesiology
(Anesthesiology)
Vol. 111
Issue 5
Pg. 1075-84
(Nov 2009)
ISSN: 1528-1175 [Electronic] United States |
PMID | 19786862
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Adrenergic alpha-Agonists
- Analgesics, Opioid
- Hypnotics and Sedatives
- Dexmedetomidine
- Morphine
- Propofol
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Topics |
- Adrenergic alpha-Agonists
(adverse effects)
- Aged
- Analgesics, Opioid
(adverse effects)
- Delirium
(chemically induced)
- Dexmedetomidine
(adverse effects)
- Double-Blind Method
- Female
- Humans
- Hypnotics and Sedatives
(adverse effects)
- Intensive Care Units
- Intra-Aortic Balloon Pumping
- Male
- Morphine
(adverse effects)
- Pain, Postoperative
(drug therapy)
- Postoperative Care
- Propofol
(administration & dosage)
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