Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So, one of our readers has written an email and said, “Hey, my mom is in intensive care, on a ventilator, in an induced coma after pneumonia. And she’s currently on midazolam and morphine infusion for sedation. And that keeps her in the induced coma.”
Midazolam is also known as Versed and she’s asking, in order to wake up, should they change midazolam or Versed to propofol? Now that’s a great question to ask, and I quickly want to make the distinction here. When you should use midazolam or Versed versus propofol?
So, propofol is a short-acting sedative. What that means is, when you use propofol and you stop propofol, patient should wake up very quickly versus if you use midazolam, it’s a long-acting sedative. And that means when you use midazolam, it takes longer for people to wake up.
The other disadvantage for midazolam or using midazolam is that, it is an addictive substance. It’s a benzodiazepine and it can make people addicted from overuse. So, when people had too much midazolam and they’re trying to get out of the induced coma, they might actually have withdrawal symptoms.
On the other hand, if you are using propofol, again, it’s a short-acting sedative and people should wake up pretty quickly once you stop propofol.
Now the side effects of Propofol are, hypotension that means blood pressure can drop quite significantly when you use propofol. And then you might need to use other life support mechanisms such as inotropes or vasopressors to sustain a physiological blood pressure.
So, there’s pros and cons for both sedatives.
For long-term sedation, if you know someone is going to be in an induced coma for quite some time, midazolam is often the better option. For short-term sedation or induced coma, propofol is the better option from my experience.
Now, to answer your question, it really depends on how long they want your mom sedated. If she’s in ICU with a pneumonia and they’ve cleared the pneumonia by using antibiotics, by using ventilation, by giving good physiotherapy and so forth, they should probably change from midazolam to propofol. Try and wake her up and hopefully she can wake up and go from there.
Now another option with sedation is often Precedex or dexmedetomidine.
Now, Precedex is a mixture of a sedative and pain relief. So, what that means is, at the moment, your mom is on midazolam and morphine. Once someone is on Precedex, it does both. It basically kills two birds with one stone. It is a sedative agent and it’s also pain relief.
Now, from my experience, Precedex doesn’t work as well as all the other sedatives, that’s just my experience. I know some people swear by it. My experience has shown that it’s not as effective as all the others, but that also means that once you stop Precedex, people can wake up a little bit quicker.
So that is my quick tip for today.
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