Xiaoping Shen, Jie Wang, Chao Zhang, Hui Cao, Baoqin Xu
In agitated patients with TBI, dexmedetomidine was associated with improved sedative and analgesic effects, more stable sedation maintenance, reduced need for additional clinical interventions, and better preservation of respiratory and hemodynamic stability, as well as cerebral oxygen metabolic balance. Propofol, inadequate analgesia, and sedation fluctuations were independent risk factors for adverse events, and dexmedetomidine specifically reduced these risks with a higher safety profile.
OBJECTIVE: To assess the analgesic and sedative efficacy of dexmedetomidine (DEX) compared with propofol in individuals suffering from traumatic brain injury (TBI).
METHODS: A total of 126 participants with TBI and agitation, who were admitted to Suzhou Ninth Hospital Affiliated to Soochow University from January 2023 to January 2025, were enrolled in this study. According to the sedative agent assigned, these participants were categorized either into Group A (DEX) or Group B (propofol). Vital signs and blood gas measurements of the two cohorts were documented and contrasted before and after treatment. The Behavioral Pain Scale (BPS) and the Richmond Agitation-Sedation Scale (RASS) were employed for evaluation and comparison purposes. The frequencies of adverse reactions, including delirium, elevated blood pressure (BP), reduced BP, and bradycardia (slowed heart rate, HR), were monitored and contrasted between the two cohorts. The analgesic effectiveness of DEX was appraised in traumatic brain injury patients, alongside an evaluation of its consequences on vital signs, blood gas parameters, and safety profile. Records were kept regarding sedative and analgesic maintenance outcomes, sedation-linked adverse occurrences, and cerebral oxygen metabolism indices. Spearman correlation and logistic regression analyses were applied to determine factors influencing adverse events.
RESULTS: At three hours following drug delivery, measurements of heart rate, mean arterial pressure, respiratory rate, and blood gas parameters in Group A were more favorable than those in Group B (P<0.05). The proportion achieving target sedation and analgesic maintenance between 12 and 24 hours was elevated in Group A, whereas the numbers of analgesic rescue events and sedation modifications, together with the risks of patient-ventilator asynchrony, unplanned extubation, and excessive sedation, were diminished in Group A relative to Group B (P<0.05). Cerebral oxygen metabolism remained more stable in Group A, accompanied by reduced concentrations of inflammatory cytokines and brain injury indicators, but elevated amounts of brain-derived neurotrophic factor (BDNF) (P<0.05). Correlation analyses indicated that pain scores were linked to indicators of inflammation and neural injury. Regression analysis identified propofol, inadequate pain management, and sedation variability as independent risk determinants for adverse events. The overall incidence of adverse events in Group A was 9.30%, which was markedly lower than the 65.00% observed in Group B (P<0.001).
CONCLUSION: In agitated patients with TBI, dexmedetomidine was associated with improved sedative and analgesic effects, more stable sedation maintenance, reduced need for additional clinical interventions, and better preservation of respiratory and hemodynamic stability, as well as cerebral oxygen metabolic balance. Propofol, inadequate analgesia, and sedation fluctuations were independent risk factors for adverse events, and dexmedetomidine specifically reduced these risks with a higher safety profile.