The Clinical Investigation about the Target-Contolled Infusing Propofol or Midazolam and Bispectral Index Applied to Sedation for Patients in ICU

Objective To investigate the predicted drug effective site concentration of propofol or midazolam making patients reach proper levels of sedation when either of these two drugs was used soley or administered synchronously in the way of TCI.To observe the correlation between BIS (bispectral index) and sedation scale.Methods 60 patients in ICU were randomly divided into three groups;propofol group (group A),midazolam group (group B) and propofol midazolam group(group C).We observed the predicted drug effective site concentration.BIS and life sign of the patients involved in these three groups at different RASS (The richmond agitation-sedation scale).The recovery time,total dosage in 8 hours and the incidence of undesired reaction of the three administration methods were compared too.Results In group A the effec- tive site concentration of propofol to keep the patient at ideal sedation level (RASS-2～-3) was 1.26±0.19～1.52± 0.18μg/ml and it was 0.50±0.95μg/ml to 1.01±0.24μg/ml in group C.In group B,the effective site concentration of midazolam was 97.05±14.51～134.75±9.66 ng/ml to make the patients at this sedation level.The corresponsive BIS was 66.10±2.52～71.05±1.45 when patients was at ideal sedation level.Among the three groups,the recovery time was simi- lar between the group A and group C,but it was longer in group B than the other groups(P0.05).The rate of sleeping a- gain is higher in group B(P0.05).There was no significant different on the rate of the hypotension and nausea among this three groups(P0.05).In the group C,the total dosage of the two sedatives to maintain the proper sedation level within 8 hours was reduced dramatically in contrast to the other two groups (P0.05).Positive eorelation was proved be- tween RASS and BIS,the coefficient of correlation was 0.93 to all of the patients(n=60,P0.01).Conclusion (1) In these three administration methods,the using solely of propofol was the most controllable but expensive,when midazolam was used solely,the recovery time was very long,thus unhandy.Contrary TCI the two drug synchronously can reduce the to- tal dosage significantly,avoid the shortcoming when neither of the two sedatives was administrated solely,retain the respec- tive merit of the two drugs at the same time.Therefore it is a perfect way for administrating sedatives in ICU。(2) BIS was highly correlated with RASS.It can be used to guide sedation and promote the security of sedation therapy.