Propofol and remifentanil versus midazolam and fentanyl for sedation during therapeutic hypothermia after cardiac arrest: a randomised trial

Abstract

Time to offset was significantly shorter in patients treated with propofol and remifentanil. However, the clinical course in 40 % of patients prevented discontinuation of sedation and potential benefits from a faster recovery. The propofol and remifentanil group required norepinephrine twice as often, but both protocols were tolerated in most patients.

Early-onset pneumonia after out-of-hospital cardiac arrest

“…74 The use of short-acting sedatives agents (propofol/remifentanil versus midazolam/fentanyl) failed to reduce the incidence of pneumonia in successfully resuscitated cardiac arrest patients. 75 …”

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

“…Finally, TTM reduces drug elimination, in particular by reducing the activity of cytochrome P450 (e.g., sedative and opiates effects are still present 24-72 h after therapy has been discontinued) and might lengthen the time of cerebral recovery [18], although this might not happen when some short-acting agents, such as propofol, remifentanil or inhaled anesthetics are used [19,20].…”

Canadian Guidelines for the use of targeted temperature management (therapeutic hypothermia) after cardiac arrest: A joint statement from The Canadian Critical Care Society (CCCS), Canadian Neurocritical Care Society (CNCCS), and the Canadian Critical Care Trials Group (CCCTG)

“…Bjelland et al randomized 59 patients to propofol/remifentanyl vs. midazolam/fentanyl, 129 and found the time to extubation was significantly shorter in the remifentanyl/propofol group. The small number of patients, as well as the fact that it was not blinded and used subjective endpoints was noted by the committee.…”