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CRITICAL CARE AND TRAUMA

Sequential Use of Midazolam and Propofol for Long-Term Sedation in Postoperative Mechanically Ventilated Patients

Masataka Saito, MD^*, Yoshiaki Terao, MD^*, Makoto Fukusaki, MD, Tetsuji Makita, MD, Osamu Shibata, MD^*, and Koji Sumikawa, MD^*

*Department of Anesthesiology and Intensive Care Unit, Nagasaki University School of Medicine, Nagasaki, Japan; and Department of Anesthesia, Nagasaki Rosai Hospital, Sasebo, Japan

Address correspondence and reprint requests to Masataka Saito, MD, Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Address e-mail to parsifal{at}net.nagasaki-u.ac.jp

Acute withdrawal syndromes, including agitation and a long weaning time, are common adverse effects after long-term sedation with midazolam. We performed this study to determine whether the sequential use of midazolam and propofol could reduce adverse effects as compared with midazolam alone. We studied 26 patients receiving mechanical ventilation for three or more days after surgery. Patients were randomly assigned to two groups. In Group M, patients were sedated with midazolam alone. In Group M-P, midazolam was switched to propofol approximately 24 h before the expected stopping of sedation. The level of sedation was maintained at 4 or 5 on the Ramsay sedation scale. The sedation agitation scale was evaluated for 24 h after extubation. The recovery time from stopping of sedation to extubation was significantly shorter in Group M-P (1.3 ± 0.4 h) compared with Group M (4.0 ± 2.4 h). The incidence of agitation in Group M-P (8%) was significantly less frequent than that in Group M (54%). The results indicate that sequential use of midazolam and propofol for long-term sedation could reduce the incidence of agitation compared with midazolam alone.

IMPLICATIONS: Our study indicates that sequential use of midazolam and propofol could reduce the incidence of agitation compared with midazolam alone.