Comparison of Gabapentin, Clonidine, and Midazolam in Intensive Care Unit Patients Undergoing Mechanical Ventilation: A Randomized Clinical Trial

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Background: Sedatives and analgesics facilitate smooth mechanical ventilation for critically ill patients. This study compared the sedative effects of gabapentin, clonidine, and midazolam in intensive care unit (ICU) patients undergoing mechanical ventilation. Methods: 90 patients were randomly assigned to one of three groups. The first group received clonidine at a dosage of 0.1 mg every 6 hours. The second group was administered 300 mg of gabapentin tablets every 8 hours. The third group received a continuous midazolam infusion at 0.07 mg/kg/hour. All groups began with an initial infusion rate of fentanyl set at 1-2 µg/kg/hour, with adjustments made every 10 minutes to achieve a Ramsay sedation score of 3-4. Fentanyl daily dose (µg/kg/hr), duration of ventilation (day), and length of ICU stay (hours) were compared among study groups. Results: Patients in the midazolam and clonidine groups required higher doses of fentanyl compared to those in the gabapentin group. The mean daily dose of fentanyl was 3.5 ± 0.1 mg (µg/kg/hour) in the clonidine group, 2.4 ± 0.04 mg in the midazolam group, and 1.9 ± 0.3 mg in the gabapentin group (p=0.003). The duration of ventilation (p=0.010) and the length of ICU stay (p=0.041) were significantly reduced in the gabapentin group when compared to the midazolam and clonidine groups. Importantly, there were no reports of severe adverse effects associated with the intervention. Conclusion: The results indicate that all treatment modalities were successful in attaining the desired levels of sedation and analgesia. Notably, gabapentin exhibited superior efficacy in achieving these targets while concurrently requiring reduced doses of fentanyl. Furthermore, patients receiving gabapentin experienced shorter durations of ICU stay and mechanical ventilation.

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