Effect of dexmedetomidine for ICU sedation in head injury patients

Introduction: Although neuro-intensive patients share many goals with general ICU patients, some indications are unique to the NICU population, such as maintaining adequate cerebral perfusion pressure (CPP), while controlling intracranial pressure (ICP) and mean arterial pressure (MAP). Materials and Methods: We compared the effect of 0.2–0.7 μg/kg/hr dexmedetomidine infusion to a standard sedative infusion of fentanyl 0.2–1 μg/kg/hr and midazolam 0.02–0.07 mg/kg/hr in 11 consecutive patients of Traumatic Brain Injury (TBI) admitted to the neurosurgical intensive care unit (NICU) in crossover alternation for the first 48 hours after admission, titrating sedation to the Richmond Agitation-Sedation Scale (RASS). Results: Patient demographics were well matched between the two groups. Hemodynamics (HR, MAP) and intracranial pressure (ICP) along with cerebral perfusion pressure (CPP) were well maintained within (P = 0.472, 0.219, 0.328, and 0.165) and between both the groups (P = 0.096, 0.432, 0.478, 0.175 respectively) and the differences were not statistically significant [Figures 2-4]. Patients in Group D had similar RASS scores to those of Group C (P = 0.894) [Figure 5]. GCS was positively correlated with RASS in Group D (P = 0.467, P = 0.021) and Group C (P = 0.654, P = 0.001). Amount and number of rescue boluses of sedation with midazolam were similar in both the groups (n = 3, P = 0.463), nor any adverse effects seen in either group. Conclusion: Dexmedetomidine is a safe alternative to conventional fentanyl and midazolam sedative infusion for TBI patients admitted to Neurosurgical Intensive Care Unit, maintaining both cardiovascular (HR, MAP) as well as cerebral (ICP, CPP) dynamics, paving the way for future exploration of dexmedetomidine for sedation for neurosurgical ICU patients.