The Use of Diazepam, Midazolam and Propofol for Sedation in the Surgical Intensive-Care Unit

Thirty critically ill patients (acute physiological and chronic health evaluation II score ＜20) in the surgical ICU were randomly allocated to 3 groups respectively to receive diazepam, midazolam or propofol sedation to facilitate mechanical ventilation over a 24-hour period. Analgesia was provided by intravenous morphine. To maintain adequate sedation, the mean total dose of diazepam given in intermittent boluses was 56.4±0.3 mg/24hr. The mean continuous infusion rates of midazolam and propofol were 0.08±0.01 mg/kg/hr and 1.4±0.5 mg/kg/hr respectively. In terms of reversibility of sedation, midazolam and propofol outscored diazepam. Recovery tended to be prolonged in patients with liver disease in all three groups, especially in the diazepam group. Systolic and diastolic blood pressures fell 30 minutes after drug administration in all groups (p＜0.05). Patients sedated with midazolam showed significant increase in oxygenation (p＜0.05). We conclude that either midazolam or propofol infusion can provide effective and safe sedation for ventilated patients in ICU.