Comparison of the Effect of Midazolam-Fentanyl with Midazolam-Fentanyl-Melatonin in Sedation of ICU Patients

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Mohammad Hossein Dehghani, Mahsa Olya, Mohammad Hossein Jarahzadeh


Background:Tolerating the endotracheal tube and mechanical ventilation are among the problems of ICU patients.This is made possible with sedation by which even duration of the use of the above procedures is shortened.There is no definite and single protocol for sedation, and most medications used are selected based on experience or availability.

Objectives: This study compared the effect of midazolam-fentanyl with midazolam-fentanyl-melatonin on sedation of ICU patients.

Methods:In this double-blind randomized clinical trial,a total of 80 patients admitted to the intensive care units of Shahid Rahnemoun Hospital in Yazd were assigned into two groups: midazolam-fentanyl and midazolam-fentanyl-melatonin.The first group of patients (midazolam-fentanyl) were treated with 0.2 mg/k/h midazolam and 1 g/kg/h fentanyl (placebo via NGT) and the second group of patients (midazolam-fentanyl-melatonin)were treated with the mentioned doses of Midazolam and fentanyl and a dose of 6 mg of melatonin administered via NGT (astwo 3-mg dosesat 8 pm and 12 pm) during mechanical ventilation.Sedation rate (from onset to 3 consecutivedays) was assessed and recorded by the researcher every 12 hours at 10 am and 10 pm using the Richmond Agitation-Sedation Scale (RASS). The two groups were further compared in terms of the average need for midazolam and fentanyl and their complications.

Results: The results showed that the two groups were similar in terms of age and sex. There was no significant difference in the RASS score (P<0.05) between the two groups at 10 am on the first day, but there was a significant difference in the evaluation at 10 pm. A better sedation was achieved on the second and third days in the melatonin group based on the RASS criterion, and the patients were in the target range, i.e.,a score of 0 to -3 (P<0.05). Besides, the mean dose of fentanyl and midazolam in the melatonin group was lower than the control group in all 3 days (P<0.05).There was no significant difference between the two groups in terms of complications such as jaundice/icterus, hypothermia and decreased hemodynamic variables.

Conclusion: Based on the findings of this study, melatonin can be used to manage sedation and reduce benzodiazepines and fentanyl in patients admitted to the intensive care unit.

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