A Study of Efficacy of Dexmedetomidine and Midazolam for Sedation of Eclamptic Patients on Mechanical Ventilation in ICU

Abstract

Introduction: Eclamptic patients often land up in Intensive Care Unit (ICU) due to complications or for further postoperative care and frequently need mechanical ventilation. Mechanical ventilation is often associated with patient agitation and reduced tolerance hence requiring sedation to alleviate discomfort and improve patient-ventilator synchrony, and also to facilitate nursing care and improve outcome. It is quite a challenge for optimum care of eclamptic patients in ICU who are usually irritable. Various agents are being used for ICU sedation, such as propofol, midazolam, fentanyl and lately dexmedetomidine. Traditionally, Midazolam has been the most commonly administered sedative drug for ICU patient’s worldwide.Materials and Methods: The present prospective study comprising of 200 eclamptic pregnant women more than 18 years of age undergoing Lower Segment Caesarean Section for termination of pregnancy under general anaesthesia and requiring postoperative mechanical ventilation in ICU at Department of Medicine, Sheikh Bhikari Medical College, Hazaribag, Kolghati, Jharkhand was planned. The study period was of one year from January 2020 to December 2020. After the approval of the institutional ethical committee, an informed written consent was taken from all patients’ first degree relatives. Results: Two Hundred patients were enrolled in the study and all completed the study. The demographic data in both the groups were statistically insignificant (Table 1). The difference in mean Ramsay Sedation Scores were statistically insignificant in both groups from 2nd to 24 hours. Haemodynamically, there was decrease in pulse rate in both the groups at all-time intervals and this decrease was significant in group II at 8th, 12th, and 24th hour (p value 0.002) in comparison to group I (Table 3). The drop in mean systolic blood pressure (and mean arterial blood pressure) was statistically significant in group II at 1st hour (p value 0.0041) and remained highly significant at 2nd to 24th hour (p value <0.0001) (Table 4 and table 6 respectively). Similarly, the drop in mean diastolic blood pressure in group II was significant at 1st and 2nd hour and it became highly significant (p value <0.0001) from 4th to 24th hour (Table 5). There were 10 patients each of bradycardia and hypotension in group II.Conclusion: In this study, we found that dexmedetomidine is as effective as midazolam for producing and maintaining adequate short-term sedation of mechanically ventilated eclampsia patients and also has good haemodynamic control. The risk of bradycardia and hypotension although higher than traditional sedatives, it may not increase length of hospital stay. Thus, dexmedetomidine could be a safe and efficacious sedative agent in eclamptic patients in ICU.