A Comparison of Propofol and
Dexmedetomidine: A Review of the Literature
Matthew Lacroix, Department of
Clinical Pharmacy Practice, College of Pharmacy and Allied Health
Professsions
V. Baldwin and A. Shah, St. John’s
University Students
Abstract: To compare propofol and
dexmedetomidine with regards to their pharmacologic,
pharmacoeconomic and therapeutic implications in the intensive care
unit. A MEDLINE search was conducted using the key words:
dexmedetomidine, propofol, and ICU sedation, dexmedetomidine versus
propofol, dexmedetomidine and intensive care unit. A
comprehensive evaluation of literature was performed.
Propofol and dexmedetomidine are centrally acting sedatives that
have distinct mechanisms of action. Propofol works on the
gamma-aminobutyric acid (GABA) receptor. Dexmedetomidine
works as an a2 agonist causing a decrease in norepinephrine release
from the locus coeruleus, suppressing central nervous system
excitation. A reduced requirement for opioids has been
reported with use of dexmedetomidine versus propofol, suggesting an
analgesic effect. Dexmedetomidine is currently indicated for
use up to 24 hours while propofol can be used for longer.
Sleep-like sedation and easy arousal are unique advantages to
dexmedetomidine allowing for neurological monitoring.
Propofol’s adverse effects include hypotension, a rare infusion
syndrome, and respiratory depression. Adverse effects of
dexmedetomide include hypotension, hypertension, and
bradycardia. Dexmedetomidine’s lack of respiratory depression
enables its use during and beyond the extubation period, while
propofol is stopped at the point of extubation. Both
medications have been shown to have similar times to extubation and
sedation. Accurate pharmacoeconomic evaluation is difficult
and mostly limited to drug cost which does not fully appreciate the
impact of a drug that is more expensive. Propofol is
available as generic, giving a slight economic advantage.
Sedation is an important aspect of care in the ICU.
Patient-specific parameters and goals should be addressed when
deciding on the proper agent for sedation. Both
dexmedetomidine and propofol offer distinct advantages and
disadvantages. Further study is warranted to better
define each agent’s role in therapy.