Comparison Between Propofol and Midazolam Infusion on Cardiovascular Stability in Critically Ill Patient
Anesthesia and cardiovascular stability
Keywords:
Propofol, Midazolam, Cardiovascular, General anesthesiaAbstract
Background: Critically ill patients often require sedation to facilitate mechanical ventilation, reduce anxiety, and minimize metabolic demands. Propofol and midazolam are commonly used intravenous sedatives in intensive care units (ICUs), but their differing pharmacological profiles raise concerns about their impact on cardiovascular stability, particularly in vulnerable patient populations.
Aim: To compare the effects of propofol and midazolam infusions on cardiovascular stability in critically ill patients, particularly those requiring sedation in an intensive care unit (ICU) setting. The study seeks to evaluate how these two commonly used sedative agents influence hemodynamic parameters, such as blood pressure, heart rate, and cardiac output, and their overall impact on cardiovascular stability.
Methods: This study was conducted in Azadi Teaching Hospital and Tikrit Teaching Hospital. The study included 75 patients admitted to the intensive care unit for the period from 15/12/2024 to 15/03/2025.
Results: The study indicated that propofol caused more hypotension (50%) and bradycardia (37.5%) as compared to midazolam (28.6% and 14.3%, respectively). However, propofol facilitated faster recovery, shorter ICU stays (average 8 vs. 10 days), and quicker weaning from mechanical ventilation (average 5 vs. 7 days). Midazolam demonstrated better cardiovascular stability and fewer adverse effects.
Conclusion: While both propofol and midazolam infusions are utilized for sedation in critically ill patients, the existing evidence suggests that propofol may be associated with a less favorable cardiovascular profile compared to midazolam. Further research, particularly large-scale randomized controlled trials is warranted to definitively elucidate the comparative effects of these agents on cardiovascular stability in this vulnerable population
References
Lia E, Pucci V, Raccagna C, Sebastiani S, Dekel B. Analgosedation Management in the Intensive Care Unit: A Narrative Systematic Review Open Anesthesia J. 2023;17: e25896458275320. DOI: 10.2174/0125896458275320231120071303, 2023, 17, e25896458275320. Arroliga AC, Jacobi J, Pandharipande PP. A study of the use of sedation in the intensive care unit. Crit Care Med. 2020;48:1234-1240.
Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al.; Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), American Society of Health-System Pharmacists (ASHP), American College of Chest Physicians. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002 Jan;30(1):119-41. doi: 10.1097/00003246-200201000-00020. Erratum in: Crit Care Med 2002 Mar;30(3):726. PMID: 11902253.
Hu A-M, Zhong X-X, Li Z, Zhang Z-J, Li H-P. Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study. Front. Pharmacol. 2021;12:614465. doi: 10.3389/fphar.2021.614465
Martin GS, Schmidit GA, Tanaka LM. Management of sepsis and septic shock. N Engl J Med. 2017;376:253-264.
Audrey S. Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Critical Care Medicine1998;26(5):947-956.
Koo, B.-W.; Na, H.-S.; Park, S.-H.; Bang, S.; Shin, H.-J. Comparison of the Safety and Efficacy of Remimazolam and Propofol for Sedation in Adults Undergoing Colonoscopy: A Meta-Analysis of Randomized Controlled Trials. Medicina 2025, 61, 646. https://doi.org/10.3390/medicina61040646
Kamath S, Hammad Altaq H, Abdo T. Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades? Microorganisms. 2023 Sep 4;11(9):2231. doi: 10.3390/microorganisms11092231. PMID: 37764075; PMCID: PMC10537306.
Mehta S, Burry L, Fischer S, Motta C, Hallett D, Boman D, et al. Canadian survey on sedative, analgesic, and neuromuscular blocking agent use in critical care. Crit Care Med. 2010;34(2):374-383.
Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, Shintani AK, Thompson JL, Jackson JC, Deppen SA, Stiles RA, Dittus RS, Bernard GR, Ely EW. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007 Dec 12;298(22):2644-53. doi: 10.1001/jama.298.22.2644. PMID: 18073360.
Ha TS, Oh DK, Lee HJ, Chang Y, Jeong IS, Sim YS, Hong SK, Park S, Suh GY, Park SY. Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines. Acute Crit Care. 2024 Feb;39(1):1-23. doi: 10.4266/acc.2024.00052. Epub 2024 Feb 28. PMID: 38476061; PMCID: PMC11002621.
Tanaka LM, Azevedo LC, Park M, Schettino G, Nassar AP, Réa-Neto A, Tannous L, de Souza-Dantas VC, Torelly A, Lisboa T, Piras C, Carvalho FB, Maia Mde O, Giannini FP, Machado FR, Dal-Pizzol F, de Carvalho AG, dos Santos RB, Tierno PF, Soares M, Salluh JI; ERICC study investigators. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study. Crit Care. 2014 Jul 21;18(4):R156. doi: 10.1186/cc13995. PMID: 25047960; PMCID: PMC4223597.
Vincent JL, Shehabi Y, Walsh TS, Pandharipande PP, Ball JA, Spronk P, Longrois D, Strøm T, Conti G, Funk GC, Badenes R, Mantz J, Spies C, Takala J. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med. 2016 Jun;42(6):962-71. doi: 10.1007/s00134-016-4297-4. Epub 2016 Apr 13. PMID: 27075762; PMCID: PMC4846689.
Aitkenhead AR, Pepperman ML, Willatts SM, Coates PD, Park GR, Bodenham AR, Collins CH, Smith MB, Ledingham IM, Wallace PG. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet. 1989 Sep 23;2(8665):704-9. doi: 10.1016/s0140-6736(89)90770-8. PMID: 2570958.
Chamorro C, de Latorre FJ, Montero A, Sánchez-Izquierdo JA, Jareño A, Moreno JA, Gonzalez E, Barrios M, Carpintero JL, Martín-Santos F, Otero B, Ginestal R. Comparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial. Crit Care Med. 1996 Jun;24(6):932-9. doi: 10.1097/00003246-199606000-00010. PMID: 8681594.
Li Y, Guo T, Yang Z, Zhang R, Wang Z and Li Y (2024) Effect of propofol versus midazolam on short-term outcomes in patients with sepsis-associated acute kidney injury. Front. Med. 11:1415425. doi: 10.3389/fmed.2024.1415425.
