A Comparison of Propofol and Dexmedetomidine: A Review of the Literature
Matthew Lacroix, Department of Clinical Pharmacy Practice, College of Pharmacy and Allied Health Professsions
V. Baldwin and A. Shah, St. John’s University Students
Abstract: To compare propofol and dexmedetomidine with regards to their pharmacologic, pharmacoeconomic and therapeutic implications in the intensive care unit. A MEDLINE search was conducted using the key words: dexmedetomidine, propofol, and ICU sedation, dexmedetomidine versus propofol, dexmedetomidine and intensive care unit. A comprehensive evaluation of literature was performed.
Propofol and dexmedetomidine are centrally acting sedatives that have distinct mechanisms of action. Propofol works on the gamma-aminobutyric acid (GABA) receptor. Dexmedetomidine works as an a2 agonist causing a decrease in norepinephrine release from the locus coeruleus, suppressing central nervous system excitation. A reduced requirement for opioids has been reported with use of dexmedetomidine versus propofol, suggesting an analgesic effect. Dexmedetomidine is currently indicated for use up to 24 hours while propofol can be used for longer. Sleep-like sedation and easy arousal are unique advantages to dexmedetomidine allowing for neurological monitoring. Propofol’s adverse effects include hypotension, a rare infusion syndrome, and respiratory depression. Adverse effects of dexmedetomide include hypotension, hypertension, and bradycardia. Dexmedetomidine’s lack of respiratory depression enables its use during and beyond the extubation period, while propofol is stopped at the point of extubation. Both medications have been shown to have similar times to extubation and sedation. Accurate pharmacoeconomic evaluation is difficult and mostly limited to drug cost which does not fully appreciate the impact of a drug that is more expensive. Propofol is available as generic, giving a slight economic advantage.
Sedation is an important aspect of care in the ICU. Patient-specific parameters and goals should be addressed when deciding on the proper agent for sedation. Both dexmedetomidine and propofol offer distinct advantages and disadvantages. Further study is warranted to better define each agent’s role in therapy.