title: Propofol and remifentanil versus midazolam and fentanyl for sedation during therapeutic hypothermia after cardiac arrest: a randomised trial.
abstract: OBJECTIVE
  To compare two protocols for sedation and analgesia during therapeutic hypothermia: midazolam and fentanyl versus propofol and remifentanil. The primary outcome was the time from discontinuation of infusions to extubation or decision not to extubate (offset time). Secondary outcomes were blood pressure, heart rate, use of vasopressors and inotropic drugs, pneumonia and neurological outcome.
  
  
  METHODS
  This was an open, randomised, controlled trial on 59 patients treated with therapeutic hypothermia (33-34 °C for 24 h) after cardiac arrest in two Norwegian university hospitals between April 2008 and May 2009. The intervention was random allocation to sedation and analgesia with propofol/remifentanil or midazolam/fentanyl.
  
  
  RESULTS
  Twenty-nine patients received propofol and remifentanil, and 30 midazolam and fentanyl. Baseline characteristics were similar. Sedation and analgesia were stopped in 35 patients, and extubation was performed in 17 of these. Sedation had to be continued for 24 patients. Time to offset was significantly lower in patients given propofol and remifentanil [mean (95 % confidence intervals) 13.2 (2.3-24) vs. 36.8 (28.5-45.1) h, respectively, p < 0.001]. Patients given propofol and remifentanil needed norepinephrine infusions twice as often (23 vs. 12 patients, p = 0.003). Incidence of pneumonia and 3-month neurological outcome were similar in the two groups.
  
  
  CONCLUSIONS
  Time to offset was significantly shorter in patients treated with propofol and remifentanil. However, the clinical course in 40 % of patients prevented discontinuation of sedation and potential benefits from a faster recovery. The propofol and remifentanil group required norepinephrine twice as often, but both protocols were tolerated in most patients.
authors.affiliation: Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway. thor.w.bjelland@ntnu.no
authors.forename: Thor W
authors.initials: TW
authors.lastname: Bjelland
authors.forename: Ola
authors.initials: O
authors.lastname: Dale
authors.forename: Kjell
authors.initials: K
authors.lastname: Kaisen
authors.forename: Bjørn O
authors.initials: BO
authors.lastname: Haugen
authors.forename: Stian
authors.initials: S
authors.lastname: Lydersen
authors.forename: Kristian
authors.initials: K
authors.lastname: Strand
authors.forename: Pål
authors.initials: P
authors.lastname: Klepstad
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D054810:Deep Sedation; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D008875:Middle Aged; D009664:Norway; D010880:Piperidines / Q000627:therapeutic use*; D015742:Propofol / Q000627:therapeutic use*; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol