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[Sedation with propofol and fentanyl in patients under intensive care]
C Beauvoir1, P Chardon, F d'Athis
1Département d'Anesthésie-Réanimation A, Hôpital Lapeyronie, Montpellier.
Insights
This study found that continuous infusions of propofol and fentanyl effectively sedated patients needing mechanical ventilation. Age-adjusted dosing led to prolonged sedation with rapid recovery times after stopping the propofol infusion.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Pharmacology and Therapeutics
Context:
- Mechanical ventilation is often required for patients with critical illnesses.
- Effective sedation is crucial for patient comfort and ventilator synchrony during prolonged mechanical ventilation.
- Propofol and fentanyl are commonly used sedatives in intensive care settings.
Purpose:
- To evaluate the efficacy and safety of a constant rate infusion of propofol and fentanyl in patients requiring mechanical ventilation for over 24 hours.
- To determine the impact of age-adjusted dosing on sedation levels and recovery times.
- To monitor hemodynamic parameters and laboratory values during and after the infusion.
Summary:
- Thirty patients requiring mechanical ventilation received age-adjusted loading doses of propofol followed by continuous infusions, along with fentanyl.
- Sedation was assessed using the Ramsay scale, with adjustments made as needed.
- Blood propofol levels correlated with administered doses, and mean sedation duration was 91.7 hours.
- Recovery times after propofol infusion cessation varied by age group, with younger patients recovering faster.
Impact:
- This study provides evidence for the effectiveness of a specific propofol and fentanyl infusion protocol in prolonged mechanical ventilation.
- Age-adjusted dosing may optimize sedation and recovery, potentially improving patient outcomes.
- Understanding the pharmacokinetics and recovery profiles is essential for clinical decision-making in intensive care units.
Abstract:
This study investigated the efficacy of a constant rate infusion of propofol and fentanyl in thirty patients requiring artificial ventilation for more than 24 h. A loading dose, which differed according to the patient's age, was administered over a 30 min period: 2.5 mg.kg-1 for patients less than 50 (G1) (n = 9), 2 mg.kg-1 for patients between 50 and 60 years old (G2) (n = 9), and 1.5 mg.kg-1 for patients over 60 (G3) (n = 12). This was followed by an infusion of 3 mg.kg-1.h-1 in G1 and G2, and 2 mg.kg-1.h-1 in G3. A 1 microgram.kg-1.h-1 infusion of fentanyl was also given. The degree of sedation was assessed with the Ramsay scale before starting, after induction, and every four hours thereafter. When this proved to be insufficient, the dose of propofol was increased by 0.5 mg.kg-1.h-1 as well as that of fentanyl by 0.5 microgram.kg-1.h-1. Heart rate, mean arterial blood pressure, blood propofol, creatinine, transaminase and lipid levels, and urine output were measured before, during, and after the infusion. The blood propofol level increased during the infusion, being correlated to the doses given (r = 0.64, p less than 0.001). Sedation lasted 91.7 +/- 57.7 h. After stopping the infusion of propofol, mean recovery times were 7.5 +/- 5.9 min (G1), 11.4 +/- 11.4 min, and 14.4 +/- 13.5 min (G3) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)