PROPOFOL OR MIDAZOLAM FOR SEDATION AND EARLY EXTUBATION FOLLOWING CARDIAC-SURGERY

Purpose: The purpose of this randomized, double-blind study was to eva luate the efficacy of midazolam and propofol for postoperative sedatio n and early extubation following cardiac surgery. Methods: ASA physica l status II-III patients scheduled to undergo elective first-time card iac surgery with an ejection fraction > 45% were eligible. All patient s received a standardized sufentanil/isoflurane anaesthesia. During ca rdiopulmonary bypass 100 mu g.kg(-1).min(-1) propofol was substituted for isoflurane. Upon arrival in the Intensive Care Unit (ICU), patient s were randomized to either 10 mu g.kg(-1).min(-1) propofol (n = 21) o r 0.25 mu g.kg(-1).min(-1) midazolam (n = 20). Infusion rates were adj usted to maintain sedation within a predetermined range (Ramsay 2-4). The infusion was terminated after four hours. Patients were weaned fro m mechanical ventilation and their tracheas extubated when haemodynami c stability, haemostasis, normothermia and mental orientation were con firmed. Haemodynamic measurements, arterial blood gas tensions and pul monary function tests were recorded at specified times. Results: There were no differences between the two groups for the time spent at each level of sedation, number of infusion rate adjustments, amount of ana lgesic and vasoactive drugs, times to awakening and extubation. The co sts of propofol were higher than those of midazolam. There were no dif ferences in haemodynamic values, arterial blood gas tensions and pulmo nary function. Conclusion: We conclude that midazolam and propofol are safe and effective sedative agents permitting early extubation in thi s selected cardiac patient population but propofol costs were higher.