title: Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients.
abstract: OBJECTIVE
  Patients on mechanical ventilation in intensive care unit (ICU) are often uncomfortable because of anxiety, pain, and endotracheal intubation; therefore, require sedation. Alpha-2 agonists are known to produce sedation. We compared clonidine and dexmedetomidine as sole agents for sedation.
  
  
  METHODS
  Prospective, randomized, controlled open-label study.
  
  
  METHODS
  A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly allocated into two groups. Group C (n = 35) received intravenous (IV) clonidine (1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation), and Group D (n = 35) received IV dexmedetomidine for sedation (loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation). A Ramsay Sedation Score of 3-4 was considered as target sedation. Additional sedation with diazepam was given when required to achieve target sedation. The quality of sedation, hemodynamic changes and adverse effects were noted and compared between the two groups.
  
  
  RESULTS
  Target sedation was achieved in 86% observations in Group D and 62% in Group C (P = 0.04). Additional sedation was needed by more patients in Group C compared with Group D (14 and 8 in Groups C and D, respectively, P = 0.034), mainly due to concomitant hypotension on increasing the dose of clonidine. Hypotension was the most common side-effect in Group C, occurring in 11/35 patients of Group C and 3/35 patients of Group D (P = 0.02). Rebound hypertension was seen in four patients receiving clonidine, but none in receiving dexmedetomidine.
  
  
  CONCLUSIONS
  Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.
authors.affiliation: Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India.
authors.forename: Uma
authors.initials: U
authors.lastname: Srivastava
authors.affiliation: Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India.
authors.forename: Mita Eunice
authors.initials: ME
authors.lastname: Sarkar
authors.affiliation: Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India.
authors.forename: Aditya
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India.
authors.forename: Amrita
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India.
authors.forename: Tapas Kumar
authors.initials: TK
authors.lastname: Singh
authors.affiliation: Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Badada
authors.affiliation: Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India.
authors.forename: Yogita
authors.initials: Y
authors.lastname: Dwivedi
keywords: Clonidine; dexmedetomidine; intensive care unit sedation
references.citation: Intensive Care Med. 1990;16(4):265-6
references.pmid: 2358560
references.citation: Anaesthesia. 1999 Dec;54(12):1136-42
references.pmid: 10594409
references.citation: J Anaesthesiol Clin Pharmacol. 2010 Oct;26(4):439-45
references.pmid: 21547166
references.citation: JAMA. 2001 Dec 5;286(21):2703-10
references.pmid: 11730446
references.citation: J Intensive Care Med. 2003 Jan-Feb;18(1):29-41
references.pmid: 15189665
references.citation: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD002024
references.pmid: 15495025
references.citation: Minerva Anestesiol. 2006 May;72(5):329-36
references.pmid: 16675941
references.citation: Middle East J Anaesthesiol. 2002 Oct;16(6):587-95
references.pmid: 12503262
references.citation: Intensive Care Med. 2010 Jun;36(6):926-39
references.pmid: 20376429
references.citation: JAMA. 2009 Feb 4;301(5):489-99
references.pmid: 19188334
references.citation: Br J Anaesth. 2001 Nov;87(5):684-90
references.pmid: 11878517
references.citation: J Intensive Care Med. 2012 Jul-Aug;27(4):219-37
references.pmid: 21525113
references.citation: Anesth Analg. 1995 Oct;81(4):706-12
references.pmid: 7573998
references.citation: Drugs. 2000 Feb;59(2):263-8; discussion 269-70
references.pmid: 10730549
references.citation: Curr Opin Crit Care. 2008 Aug;14(4):403-7
references.pmid: 18614903
references.citation: Indian J Anaesth. 2011 Jul;55(4):323-4
references.pmid: 22013245
references.citation: Anesthesiology. 1992 Dec;77(6):1134-42
references.pmid: 1361311
references.citation: Br J Anaesth. 2001 Jan;86(1):5-11
references.pmid: 11575409
references.citation: Intensive Care Med. 2004 Dec;30(12):2188-96
references.pmid: 15338124
references.citation: JAMA. 2007 Dec 12;298(22):2644-53
references.pmid: 18073360
references.citation: Intensive Care Med. 2003 Feb;29(2):201-7
references.pmid: 12594584