Anesthesia E-ssential, April 13, 2012

 
Anesthesia E-ssential

April 13, 2012

 

Vital Signs

 
Potential for Wrong Route Errors with Exparel
An alert is being issued to inform health professionals about a potential medication safety issue with Exparel (bupivacaine liposome injectable suspension): possible confusion with propofol.
 
There is a dangerous potential for errors in the administration of two "look-alike" medications that are or will be common in anesthesia practice in this country: propofol and the new bupivacaine liposomal suspension Exparel, which is not meant for IV administration. Both are milky white suspensions, and because propofol has been the only such medication for many years, a real potential for error exists. Click here to learn more.
 

The Pulse

Inside the Association
 
Hot Topics
  • Propofol Returns to Shortage List
  • Dispose of Prescription Drugs and Support the National Take-Back Initiative
  • HVO Needs Pediatric Nurse Anesthesia Volunteers
 
AANA Foundation and Research
  • AANA Foundation General Poster Session Application Deadline is May 1, 2012
 
News from COA
  • Ensuring Quality in Nurse Anesthesia Education
 
Federal Government Affairs and PAC
  • Supreme Court Concludes Oral Arguments on Health Reform, Summer Decision Expected
  • AANA Commends FTC for Supporting Choice, Access, Competition in Healthcare
  • Medicare Updates 2012 Part B Anesthesia Conversion Factors
  • AANA Urges Support for Nurse Work Force Development, Research
  • Medicare Fixes “Graduate Nursing Education” Application to Allow Doctoral Program Participation; Educational Webinar Available April 18
  •  U.S. House OKs Budget Recommending Spending Cuts, Medicare Changes
  • AANA Publishes New Resource on CRNA Reimbursement
  • Not Attending Mid-Year Assembly? Participate Virtually
  • FEDERAL ELECTION COMMISSION REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC

Jobs

  • Visit the Career Center
 

Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.
  • Influence of Gender and Anesthesia Type on Day Surgery Anxiety
  • Hospitals Scramble on the Front Lines of Drug Shortages
  • Pediatric Dentists Want Anesthesiology Help
  • Recovery From Propofol Anesthesia May Be Sped by Use of Common Stimulant
  • Scientists Image Process of Consciousness After General Anesthesia
  • Local Anesthesia Superior to Opioids for Pain Management After TKA
  • A Prospective, Randomized, Double-Blinded Comparison Between Multimodal Thoracic Paravertebral Bupivacaine and Levobupivacaine Analgesia
  • Neuromuscular Blockers Linked to Post-Op Breathing Problems
  • Treatments to Reduce Anesthesia-Induced Injury in Children Show Promise in Animal Studies
  • Study Examines Patient Head Positioning During IJV Cannulation
  • Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation
 

 
Inside the Association

Hot Topics

Propofol Returns to Shortage List
The U.S. Food and Drug Administration has placed propofol back on its drug shortages list. Visit the AANA website’s Current Anesthesia Related Drug Shortages webpage, located in the Professional Practice section, for further information about this and other drug shortages.
 
Dispose of Prescription Drugs and Support the National Take-Back Initiative
April 28, 2012
10 a.m.–2 p.m. Local Time

Prescription drugs are being misused and abused at alarming rates throughout the United States. As part of the effort to address this problem, the U.S. Drug Enforcement Administration has designated April 28 as the 4th National Prescription Take-Back Day to collect potentially dangerous expired, unused, and unwanted prescription drugs for destruction at sites nationwide. Click here to learn more.

 
HVO Needs Pediatric Nurse Anesthesia Volunteers
Health Volunteers Overseas (HVO) needs CRNAs with significant pediatric experience for 2 - 4 week assignments at Angkor Hospital for Children in Siem Reap, Cambodia. Volunteers will provide teaching and clinical training to nurses practicing anesthesia. Please contact the program department for more information.


For the latest AANA News, visit the AANA Facebook page and follow "aanawebupdates" on Twitter
 

 
 

AANA Foundation and Research

AANA Foundation General Poster Session Application Deadline is May 1, 2012
The “State of the Science” General Poster Session welcomes all researchers in anesthesia. The posters will be displayed in the Exhibit Hall at the Annual Meeting this August in San Francisco, Calif. Recipients of AANA Foundation grants and awards are encouraged and eligible to apply. Encore posters are also welcome to apply. Visit www.aanafoundation.com to download the application.
 
Posters selected for presentation are judged as follows:
 
A. Categories are education, leadership, practice, healthcare policy, and science of anesthesia. A winner will be selected in each category, signified by a blue ribbon at the opening of the Exhibit Hall at the Annual Meeting.
 
B. Content of the abstract to be reviewed includes background/literature review, problem and hypothesis, material and methods, results, conclusions/discussion, and significance, application, and future research.
 
C. Presentation of the poster must be: organized/easy to follow; font sizes are at least 24 point); color, tables, graphs, data, and photos are used advantageously; and acknowledgements, funding, and affiliation are represented.
 

 
 

News from COA

Ensuring Quality in Nurse Anesthesia Education
The two fundamental reasons for accreditation are to ensure quality assessment and improvement. The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) accomplishes this by several different activities. One method is the monitoring of programs’ National Certification Exam (NCE) pass rates. A second method is monitoring programs' growth based on headcount enrollment.
 
One important measure of student learning is the ability of graduates to pass the NCE. At its upcoming May meeting, the COA will be reviewing programs’ certification exam pass rates to determine if programs’ pass rates on the NCE are in accordance with the COA pass rate requirement. Programs that have NCE pass rates lower than the established COA mandatory pass rate for the calendar year under review are placed into monitoring and receive a letter of concern, which will direct the program to immediately develop and implement a plan designed to improve their graduates’ ability to pass the NCE.
 
Recently, the COA implemented a policy to monitor program growth (reference Monitoring Program Growth and Headcount Enrollment policy at http://home.coa.us.com by clicking on the Accreditation tab). The COA monitors programs’ growth in order to ensure that programs experiencing substantial growth have adequate resources to provide for the total number of students.
 
The draft Practice Doctorate Standards call for even tighter monitoring of program growth. Monitoring COA pass rate requirements and program growth are two examples of processes the COA has established to assess quality and encourage improvement in nurse anesthesia programs.
 
For additional information on the COA’s quality assessment and improvement activities, please contact the COA at accreditation@coa.us.com.
 
 
Supreme Court Concludes Oral Arguments on Health Reform, Summer Decision Expected
On March 28, the U.S. Supreme Court concluded three days of oral arguments on the constitutionality of the Affordable Care Act health reform law, leaving CRNAs, lawmakers, and the healthcare industry guessing about what decision the high court might make this coming June.
 
The high court argument reviewed whether the law’s requirement that a person must buy health coverage or pay a penalty is constitutional, and whether the law’s expansion of Medicaid operated by the states is constitutional. Justices also discussed whether deciding part of the law is unconstitutional would invalidate the whole thing, but did not come to any conclusion during the oral arguments.
 
If the entire law is ruled unconstitutional, the fate of provisions affecting CRNAs that the AANA supported or commented upon would be in disarray. These provisions include the provider nondiscrimination provision due to take effect in 2014, the Graduate Nursing Education (GNE) demonstration project, the Title 8 nurse work force development program authorization, federal rules governing state-based health coverage exchanges, and federal rules governing Accountable Care Organizations (ACOs) to name a few.
 
Meanwhile, commercial plans say their own private reform efforts will continue notwithstanding any Supreme Court decision, according to an April 2 WNPR report.
 
Read comprehensive nonpartisan health industry coverage of the high court’s oral arguments.
 
Read the transcripts (select those of March 26, 27 or 28).
 
 

AANA Commends FTC for Supporting Choice, Access, Competition in Healthcare
The AANA commends the Federal Trade Commission (FTC) for supporting patient choice, access to care, and competition that helps control healthcare costs, in a letter AANA President Debra Malina, CRNA, DNSc, MBA, sent the FTC in late March.
 
“Within the past several months, the FTC has expressed opinions on proposed regulation and legislation, in Alabama and Tennessee respectively, that would have restricted the use of CRNAs to perform services within their education and training and restricted patient access to their services,” Malina wrote. “Such anticompetitive restrictions on patient access to CRNA care diminish competition, impair free markets for healthcare services, risk cost increases to our already costly health system, and fail to improve patient safety. By responding to state-based requests to evaluate state regulatory and legislative proposals that risk patient access to quality healthcare, the FTC is fulfilling its duty to promote market competition and its benefits.”
 
Medicare Updates 2012 Part B Anesthesia Conversion Factors
Anesthesia services provided to Medicare patients for the remaining months of 2012 will be reimbursed at an average $21.52 per unit, up about 1.7 percent from the previous 2012 figure of $21.41 per unit, according to figures provided to the AANA by the Medicare agency. Medicare Part B pays for anesthesia services by the formula: (base units plus time units) times (dollar value anesthesia conversion factor).
 
Actual Medicare reimbursement figures and changes vary by locality, based on agency surveys of labor costs, practice expense costs, and real estate costs. Medicare anesthesia services for Carrier 14202 locality 99, “Rest of Massachusetts,” will see a 0.56 percent bump up to $21.54 per unit. Services for Carrier 10102 locality 00, Alabama will see a 0.45 percent bump. Medicare Part B 2012 anesthesia conversion factors vary from a low of $20.06 per unit for services delivered in Arkansas to a high of $29.33 per unit for services delivered in Alaska.
 
The updated anesthesia conversion factors are in effect for Medicare Part B services delivered between March 1 and Dec. 31, 2012.
 
AANA Urges Support for Nurse Work Force Development, Research
In written testimony to the House and Senate appropriations subcommittees on Labor-HHS-Education, the AANA and coalitions representing nurses and APRNs have requested support for nurse work force development and nursing research funding in FY 2013 appropriations bills.
 
The AANA’s testimony urges Congress to provide the president’s budget levels for Title 8 nurse work force development ($251 million) including advanced nursing education ($84 million), and for the work of the Centers for Disease Control Division of Healthcare Quality and Promotion with respect to promoting safe injection practices. The AANA testimony also urges funding for CRNA work force development ($3 million to $4 million). AANA-backed testimony submitted by The Nursing Community and by Americans for Nursing Shortage Relief (ANSR) makes similar requests.
 
Medicare Fixes “Graduate Nursing Education” Application to Allow Doctoral Program Participation; Educational Webinar Available April 18
The Medicare agency has updated its guidance for applicants to the new Graduate Nursing Education (GNE) demonstration project so doctoral CRNA and APRN educational programs can participate. The initial guidance limited APRN program participation to master’s level education only. AANA and several APRN groups had requested the change.
 
In addition, the AANA urges prospective applicants to participate in a webinar sponsored by the Medicare agency Wed., April 18, from 2 – 3:30 p.m. Eastern time, about the GNE program. The webinar is for APRN educational program officials who are considering working with hospitals to submit an application for GNE funding.
 
 

U.S. House OKs Budget Recommending Spending Cuts, Medicare Changes
The U.S. House passed, along party lines, a budget plan sponsored by Rep. Paul Ryan, R-Wis., which recommends substantial changes in the structure of the Medicare and Medicaid health programs critical to CRNAs.
 
The budget proposal also offers lower overall spending levels than those provided by the 2011 Budget Control Act that would place downward pressure on nurse work force development and research programs advocated by CRNAs. The vote on the budget (H. Con. Res. 112, http://thomas.loc.gov/cgi-bin/bdquery/z?d112:h.con.res.00112:) March 29 was 228-191, with all but 10 Republicans voting for it and all Democrats voting against.
 
Its outlook in the U.S. Senate, however, is dim. The Democratic majority Senate and the Obama-Biden Administration oppose the House-passed budget proposal. However, the House measure will affect how House appropriations panels draw up spending bills for the 2013 fiscal year.
 
See how your U.S. House representative voted at http://clerk.house.gov/evs/2012/roll151.xml.
 

AANA Publishes New Resource on CRNA Reimbursement
In response to AANA member requests for more in-depth information on CRNA reimbursement and issues affecting the market for CRNA services, the AANA has published a new online document titled “Issue Briefs on Reimbursement and Nurse Anesthesia.” (Link requires AANA member login and password.)
 
Initially developed for participants in the AANA 2011 Summit on Anesthesia Reimbursement, this new AANA document includes updates reflecting developments in Medicare, Medicaid and other public benefit programs, commercial health plans, pain management reimbursement, and health reform implementation. The document provides helpful links to other resources that AANA members might find useful in learning more about the economic and reimbursement factors shaping the present and future of CRNA practice.
 
Not Attending Mid-Year Assembly? Participate Virtually
If you’re not among the 800 or so AANA members participating in AANA Mid-Year Assembly in Washington April 15-18, the AANA invites you to participate in virtual visits with your members of Congress on issues your colleagues bring to Capitol Hill in person. Keep an eye on your email inbox for more details!
 
 
FEDERAL ELECTION COMMISSION REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC 
Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use our best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. I am a US Citizen.
 
 
 

Jobs

Visit the AANA Career Center
 

 

Healthcare Headlines

Influence of Gender and Anesthesia Type on Day Surgery Anxiety
Elective surgery received on a day or short-stay basis is on the rise, and preoperative apprehension can be considerable. As part of a larger study, researchers looked at 674 responses to a questionnaire sent to patients undergoing day surgery with anesthesia from 2005 to 2007. Of the total respondents, 82.4 percent experienced anxiety on the day of surgery. The patients cited the wait, anesthesia, and the possibility of pain as common anxiety-provoking factors. Most patients preferred to receive information between one and four weeks before surgery; however, participants undergoing general anesthesia said they would prefer information at a statistically significantly earlier stage. General anesthesia patients were much more anxious than individuals who received local anesthesia. Female patients reported more anxiety and said they preferred to wait with a relative or friend.
 
From "Influence of Gender and Anesthesia Type on Day Surgery Anxiety"
Journal of Advanced Nursing (05/12) Vol. 68, No. 5, P. 1014 Mitchell, M.
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Hospitals Scramble on the Front Lines of Drug Shortages
The scarcity of certain drugs—including those used to anesthetize surgical patients and to alleviate pain—has been an escalating problem for several years now, finally hitting record proportions in 2011. The phaseout of older drugs for newer ones, as well as quality problems such as fungal contamination, are the primary reasons for the shortages. Manufacturing shutdowns play a role as well. "Right now, anesthesia is a big concern," points out Valerie Jensen, associate director of the Food and Drug Administration's drug-shortage program. "These drugs are absolutely in critical shortage." Hospitals have been forced to ration medications, use more expensive alternatives, and even postpone critical treatments as a result. The fallout, according to the Institute for Safe Medication Practices, has included numerous injuries—and even some deaths—as healthcare workers make errors in dosing and preparing substitutes. Some hospitals have resorted to mixing drugs themselves, for their own use. Not only is this legal, say pharmacists, it reduces the chances of a mistake. As hospital staffers struggle daily to manage shortages and avert crises, federal regulators are fast-tracking the process for some upstart firms to produce older drugs. Additionally, manufacturers are providing earlier notification when a drug is in danger of going into short supply.
 
From "Hospitals Scramble on the Front Lines of Drug Shortages"
Washington Post (DC) (04/10/12) Sun, Lena H.
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Pediatric Dentists Want Anesthesiology Help
Pediatric dentists are experiencing a shortage of dental anesthesia providers, according to a survey of 494 pediatric dentists published in the journal Anesthesia Progress. Responses differed by region, sex, and length of practice. Between 20 percent and 40 percent of pediatric dentists said that they currently use a dental anesthesia provider; but 60 percent to 70 percent said that they would use one if available. A separate survey of dental anesthesiology program directors, published in the same journal, found that demand for dental anesthesia providers has been increasing in recent years. While dentists have usually provided both anesthesia and dental care, many more pediatric dentists now prefer to leave the anesthesia to others while they concentrate on the dentistry. Some researchers have become aware of the need for anesthesia in their patients because many low-income patients require extensive dental work that often calls for general anesthesia. Due to the increasing demand, there is a greater need for more training programs for dental anesthesia providers. Bringing an anesthesia provider into the office can cost half as much as taking the patient to a hospital or day-surgery center for anesthesia.
 
From "Pediatric Dentists Want Anesthesiology Help"
Medscape (04/06/12) Harrison, Laird
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Recovery From Propofol Anesthesia May Be Sped by Use of Common Stimulant
The common stimulant methylphenidate (Ritalin) can speed recovery from general anesthesia. This ability seems to apply both to anesthesia from inhaled isoflurane and to intravenous propofol. Researchers report their study findings in the May issue of Anesthesiology. Previous research, published in the October 2011 issue of Anesthesiology, showed that methylphenidate significantly decreased the amount of time needed to recover from isoflurane anesthesia. The newer study found similar effects when propofol was the anesthetic agent. Laboratory rats that had lost consciousness after one dose of propofol were then given intravenous methylphenidate or saline. The rats that received methylphenidate recovered almost five minutes faster than those that received saline. EEG brain readings showed that methylphenidate caused brain activity to shift back toward the awake state. The researchers noted that if a patient is oversedated with propofol, methylphenidate may help him or her wake up and resume breathing and normal blood pressure. After surgery, patients may take as long as an hour to recover from anesthesia with propofol. Use of methylphenidate to induce recovery could increase the safety and efficiency of general anesthesia.
 
From "Recovery From Propofol Anesthesia May Be Sped by Use of Common Stimulant"
EurekAlert (04/05/12)
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Scientists Image Process of Consciousness After General Anesthesia
When waking up from anesthesia, patients often experience an initial phase of delirious struggle before full awareness and orientation is restored. Scientists now know that this may occur because the primitive consciousness emerges first. Researchers in Finland conducted brain imaging on 20 healthy volunteers to image the process of returning consciousness after general anesthesia. Consciousness was associated with activations of deep, primitive brain structures instead of the evolutionary younger neocortex. Results showed that the central core structures of more primitive brain structures, such as the thalamus and parts of the limbic system, regained function first. Researchers had expected to see the cerebral cortex resume function first. Study subjects underwent anesthesia in a brain scanner using either dexme-detomidine or propofol anesthetic drugs. Positron emission tomography imaged state-related changes in brain activity. This study was part of the Research Program on Neuroscience by the Academy of Finland.
 
From "Scientists Image Process of Consciousness After General Anesthesia"
News-Medical.Net (04/05/12)
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Local Anesthesia Superior to Opioids for Pain Management After TKA
Patients who receive total knee arthroplasty may have better pain management with intra-articular catheters filled with bupivicaine than traditional opioids, according to a level 1 study for pain management, presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Researchers at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia looked at 150 patients who underwent unilateral total knee arthroplasty. Patients were randomized to receive an intra-articular catheter that continuously delivered either 0.5 percent bupivicaine or a placebo solution for two days after surgery. Study participants completed Visual Analog Scale questionnaires at 5:00 p.m. on the day of surgery, at 8:00 a.m. and 5:00 p.m. every day after surgery until discharge, and then at a four-week follow-up. Those who received bupivicaine had the least pain and lowest narcotics consumption. There was no significant difference between the groups in terms of postoperative complications. The researchers recommend further study on this potential new option for pain management after knee replacement.
 
From "Local Anesthesia Superior to Opioids for Pain Management After TKA"
Ortho Supersite (04/05/12)
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A Prospective, Randomized, Double-Blinded Comparison Between Multimodal Thoracic Paravertebral Bupivacaine and Levobupivacaine Analgesia
Paravertebral analgesia with levobupivacaine is superior to paravertebral analgesia with bupivacaine in mitigating pain during and after lung surgery, report researchers in Slovenia. The finding is based on a prospective, randomized, and double-blinded study of 40 patients having thoracic surgery. Patients received paravertebral catheterization and one of the two types of analgesia, followed by propofol anesthesia. A continuous infusion of bupivacaine of levobupivacaine—with morphine and clonidine added—was given to patients for 72 hours after their procedure, with rescue diclofenac analgesia dispensed as necessary. According to the team from University Medical Center in Ljubljana, intraoperative fentanyl consumption was lower in patients in the levobupivacaine group, who also reported lower pain scores and required less rescue analgesia than the bupivacaine group.
 
From "A Prospective, Randomized, Double-Blinded Comparison Between Multimodal Thoracic Paravertebral Bupivacaine and Levobupivacaine Analgesia"
Journal of Cardiothoracic and Vascular Anesthesia (04/04/12) Novak-Jankovic, V.; Milan, Z.; Potocnik, I.; et al.
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Neuromuscular Blockers Linked to Post-Op Breathing Problems
A team of Boston researchers has found that intermediate-acting neuromuscular blocking agents are associated with increased adverse respiratory outcomes after surgery. Use of neostigmine for neuromuscular blockade reversal was also associated with increased hypoxic events. Using data from 57,100 surgical cases that required intubation between March 2006 and September 2010, the researchers made a list of variables known to contribute to adverse postoperative respiratory outcome. Two variables defined as representative of adverse respiratory outcome were oxygen desaturation after extubation to a level lower than 90 in the operating room and re-intubation or unplanned intensive care unit (ICU) admission. Neuromuscular blockade with vecuronium, rocuronium, and cisatracurium was connected to greater risk for hypoxic events after extubation and higher risk for re-intubation/unplanned ICU admission. These associations were still significant after controlling for the known contributing factors, including age, sex, body-mass index, Charlson Comorbidity Index, and emergency status. Use of neuromuscular blockers did not independently predict mortality or length of hospitalization. Neither objective monitoring nor reversal with neostigmine at the end of the case appeared to reduce the occurrence of adverse events. Based on their findings, the researchers recommend that anesthesia providers include neuromuscular monitoring in their care regimens.
 
From "Neuromuscular Blockers Linked to Post-Op Breathing Problems"
Anesthesiology News (04/01/12) Vol. 38, No. 4 Vlessides, Michael
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Treatments to Reduce Anesthesia-Induced Injury in Children Show Promise in Animal Studies
A new study published online in the March 23 online edition of the journal Neuroscience may pave the way for treatment options that could protect young children from the adverse effects of anesthesia. The scientists conducted their research in animal models with rats of ages equivalent to children ranging in age from birth to age four. They tested the efficacy of four treatment options: aspirin, vitamin D3, a fragment (NAP) of the neuroprotective protein ADNP, and a low-level dose of anesthetic. Researchers were surprised to find that not only was aspirin ineffective against the anesthetic ketamine, but it actually increased the severity of anesthesia-related injuries. They found that the other treatment options proved effective, although more study is needed for NAP, as there may be a critical window of efficacy for this treatment option. The recommended treatment was the low-level dose of ketamine, which was the simplest and most cost-effective method. This strategy "suggests that children can be pre-treated with the same anesthesia that will be used when they undergo general surgery," said the study's lead author, Christopher Turner. "In essence, a low-level dose of ketamine primes the child's brain so that the second, higher dose is not as lethal, much like an inoculation."
 
From "Treatments to Reduce Anesthesia-Induced Injury in Children Show Promise in Animal Studies"
Medical Xpress (03/28/12)
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Study Examines Patient Head Positioning During IJV Cannulation
When ultrasound-guided internal jugular vein cannulation is performed, the patient's head can be placed in either a neutral position or in a 45-degree neck rotation, with no difference in safety. Investigators reached this conclusion based on the results of 662 patients who were placed in the former position and 670 who were placed in the latter. IJV cannulation was equally successful in all of the test subjects. The research was published in the April issue of Anesthesia & Analgesia.
 
From "Study Examines Patient Head Positioning During IJV Cannulation"
Becker's ASC Review (03/12) Tawoda, Taryn
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Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation
Researchers examined the efficacy of dexmedetomidine for maintaining long-term, light to moderate sedation in intensive care units as an alternative to midazolam and propofol, which can present serious adverse effects in this setting. The investigators conducted a pair of randomized, double-blind trials (MIDEX and PRODEX) between 2007 and 2010. MIDEX compared dexmedetomidine to midazolam in the ICUs of 44 clinical centers in nine European countries, while PRODEX compared dexmedetomidine to propofol in the ICUs of 31 centers in six European countries. The researchers tested whether dexmedetomidine was noninferior to control in regards to proportion of time at the target sedation level and whether it was superior to control in terms of length of time on mechanical ventilation. They found that dexmedetomidine was inferior to neither midazolam or propofol in maintaining light to moderate sedation. Dexmedetomidine also proved to reduce the amount of time patients spent on mechanical ventilation compared to midazolam, but not to propofol; and patients on dexmedetomidine were better able to communicate pain compared to both of the other anesthetics. However, it was discovered that dexmedetomidine was associated with more adverse side effects, included bradycardia and hypotension, as compared to midazolam, but was equivalent to propofol. The researchers concluded that dexmedetomidine was feasible for use as a long-term sedative in intensive-care patients and could provide clinically relevant benefits.
 
From "Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation"
Journal of the American Medical Association (03/21/12) Vol. 307, No. 11, P. 1151 Jakob, Stephan M.; Ruokonen, Esko; Grounds, R. Michael; et al.
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