A comparison of severe hemodynamic disturbances between dexmedetomidine and propofol for sedation in neurocritical care patients.
OBJECTIVE
Dexmedetomidine and propofol are commonly used sedatives in neurocritical care as they allow for frequent neurologic examinations. However, both agents are associated with significant hemodynamic side effects. The primary objective of this study is to compare the prevalence of severe hemodynamic effects in neurocritical care patients receiving dexmedetomidine and propofol.


METHODS
Multicenter, retrospective, propensity-matched cohort study.


METHODS
Neurocritical care units at two academic medical centers with dedicated neurocritical care teams and board-certified neurointensivists.


METHODS
Neurocritical care patients admitted between July 2009 and September 2012 were evaluated and then matched 1:1 based on propensity scoring of baseline characteristics.


METHODS
Continuous sedation with dexmedetomidine or propofol.


RESULTS
A total of 342 patients (105 dexmedetomidine and 237 propofol) were included in the analysis, with 190 matched (95 in each group) by propensity score. The primary outcome of this study was a composite of severe hypotension (mean arterial pressure < 60 mm Hg) and bradycardia (heart rate < 50 beats/min) during sedative infusion. No difference in the primary composite outcome in both the unmatched (30% vs 30%, p = 0.94) or matched cohorts (28% vs 34%, p = 0.35) could be found. When analyzed separately, no differences could be found in the prevalence of severe hypotension or bradycardia in either the unmatched or matched cohorts.


CONCLUSIONS
Severe hypotension and bradycardia occur at similar prevalence in neurocritical care patients who receive dexmedetomidine or propofol. Providers should similarly consider the likelihood of hypotension or bradycardia before starting either sedative.
1Department of Pharmacy, University of Florida Health, Jacksonville, FL. 2Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH. 3The Ohio State University, College of Pharmacy, Columbus, OH. 4The Ohio State University Center for Biostatistics, Columbus, OH. 5University of Tennessee, College of Medicine, Memphis, TN. 6Semmes-Murphey Neurologic and Spine Institute, Memphis, TN. 7Department of Pharmacy, Methodist Healthcare-University Hospital, Memphis, TN. 8University of Tennessee, College of Pharmacy, Memphis, TN.
Michael J
MJ
Erdman
Bruce A
BA
Doepker
Anthony T
AT
Gerlach
Gary S
GS
Phillips
Lucas
L
Elijovich
G Morgan
GM
Jones
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000209:etiology; D003422:Critical Care / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006305:Health Status Indicators; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007022:Hypotension / Q000209:etiology; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000628:therapy*; D015995:Prevalence; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol