Effects of Propranolol Administration on Sedative and Analgesia Requirements in Traumatic Brain Injury Patients

Abstract

Specific Aims: To evaluate the use of propranolol in reducing sedative and analgesic requirements among adult critical care patients with confirmed traumatic brain injury (TBI). Methods: This retrospective, multicenter observational study conducted at Banner Health Hospitals included patients with moderate-to-severe TBI (Glasgow Coma Scale [GCS] 3-12) who received at least 48-hours of propranolol within the first 3 days of an intensive care unit (ICU) admission with concurrent sedative and/or analgesic therapy. Medical records were reviewed for patients admitted between November 1, 2017, and February 28, 2023. The primary outcome was the effect of propranolol initiation on 24-hour propofol and dexmedetomidine dosing requirements. Secondary outcomes included the effect of propranolol on 48-hour propofol and dexmedetomidine requirements and, 24- and 48-hour ketamine, benzodiazepine, and opioid requirements. Results: Ninety-six patients were included in the study. While there was no notable difference in 24-hour propofol (p = 0.329) requirements, there was a significant increase in 24-hour dexmedetomidine (p = 0.047) requirements. There was a significant increase in the 48-hour dexmedetomidine (p = 0.002) and ketamine (p = 0.05) requirements. A significant decrease in the 48-hour propofol (p = 0.003), ketamine (p = 0.05), and opioids (p = 0.025) requirements and respective 24- and 48-hour benzodiazepine (p = 0.015, P = 0.027) requirements was demonstrated. There were no differences in 24-hour ketamine and opioid requirements. Conclusions: Propranolol administration within 3-days after moderate-to-severe TBI insult may facilitate the transition from a deeper sedative agent to a less sedating agent in the ICU setting.