A comparison of propofol and other sedative use in paediatric intensive care in the United Kingdom.

The retrospective study was designed to examine the safety of propofol against other sedative agents when used by infusion for the sedation of children requiring mechanical ventilation. One-hundred-and-ninety-eight patients were recruited. One-hundred-and-six received propofol and 92 received other sedative agents for durations of 30 min to 156 days and 13 min to 11 days respectively. The mean infusion rate of propofol was 3.39 mg.kg-1.h-1. Sixty-one of the 92 patients in the nonpropofol group received midazolam at a mean infusion rate of 0.4 mg.kg-1.h-1. Forty-one patients developed clinical metabolic acidosis with five falling into the pathological range as defined. Seventeen received propofol and 24 another sedative agent. Seventy-eight percent of patients that became acidotic were under the age of three. No patients who became acidotic was noted to have lipaemic serum. Three of four patients were recorded as having lipaemic serum received propofol, however two of these patients along with the patient that received midazolam also received Intralipid. Overall mortality was similar in both sedation groups with 27 deaths being recorded. Thirteen patients received propofol. Five nonfatal adverse events occurred, three in patients that had received propofol. The findings of the survey suggest that propofol compares favourably with other sedative agents when used for sedating children in a paediatric intensive care unit.

Double-blind study of the reversal of midazolam-induced sedation in the intensive care unit with flumazenil (Ro 15-1788): effect on weaning from ventilation.

Midazolam (0.1-0.2 mg/kg/hr) and morphine (2 mg/hr) were given by carefully regulated continuous intravenous infusions to thirty patients who required sedation, analgesia and ventilation for between twelve and twenty-four hours in the Intensive Care Unit. The midazolam and morphine infusions were stopped at the end of the period of sedation required and the efficacy of placebo of flumazenil in reversing the sedative effects of midazolam was compared in this double-blind randomised parallel group study. Patients receiving flumazenil were less sedated (P less than 0.05), able to obey commands (P less than 0.05), weaned from ventilation (P less than 0.05) and extubated (P less than 0.05) significantly earlier than those receiving placebo.

The M1 air crash. The demands placed on anaesthetic and intensive care services of two hospitals.

The M1 air crash provided an enormous challenge to the anaesthetic and intensive care services of the hospitals which admitted the survivors, many of whom had serious injuries. This account describes some of the problems which were encountered in two of the hospitals, details the workload imposed on the anaesthetists and the staff of the Intensive Therapy Units and identifies factors which, if improved, might advance the management of multiple casualties admitted from the scene of a major disaster.

Comparison of propofol and midazolam for sedation in critically ill patients.

101 critically ill patients admitted to five intensive-care units were allocated randomly to receive a continuous intravenous infusion of either propofol or midazolam for sedation for up to 24 h. In addition, morphine was given to provide analgesia. The mean duration of infusion was 20.2 h (range 3.0-24.5) in the propofol group and 21.3 h (4.0-47.0) in the midazolam group and infusion rates were 1.77 mg/kg/h (range 0.40-5.00) and 0.10 mg/kg/h (0.01-0.26), respectively. The infusion rates were adjusted as necessary, and the desired level of sedation was achieved easily in most patients in both groups. There were slight falls in arterial pressure, but there were no significant differences between the groups. Heart rate was lower in patients who received propofol. Some small changes occurred in biochemical and haematological variables in both groups, but they were not clinically significant. There was no indication that either drug substantially impaired adrenal steroidogenesis. When the infusion was discontinued, there was less variability in recovery of consciousness in patients who had received propofol. In a subgroup of patients, weaning from mechanical ventilation was achieved significantly faster after discontinuation of propofol than of midazolam. Propofol proved to be a satisfactory agent for sedation of these critically ill patients and compared favourably with midazolam.