Comparison of Dexmedetomidine versus Propofol for Sedation in Mechanically Ventilated Patients after Cardiovascular Surgery

Abstract

Many cardiovascular surgeries are fast-tracked to extubation and require short-term sedation. Dexmedetomidine and propofol have very different mechanisms of action and pharmacokinetic profiles that make them attractive sedative agents in this patient population. Recently, there has been increased use of dexmedetomidine in the intensive care unit (ICU), but few studies exist or have been published directly comparing both agents in this setting. We conducted a retrospective cohort study with patients admitted to the ICU after cardiovascular surgery from January through June 2011. Adult patients who underwent coronary artery bypass and/or cardiac valve surgery received either dexmedetomidine or propofol continuous infusion for short-term sedation after cardiovascular surgery. The primary end point was time (hours) on mechanical ventilation after surgery. Secondary end points included ICU length of stay (LOS), hospital LOS, incidence of delirium, and requirement of a second sedative agent. A total of 352 patients met study inclusion criteria, with 33 enrolled in the dexmedetomidine group and 319 in the propofol group. Time on mechanical ventilation was shorter in the dexmedetomidine group (7.4 hours vs. 12.9 hours, P = .042). No difference was seen in ICU or hospital LOS. The need for a second sedative agent to achieve optimal sedation (24% vs. 27%, P = .737) and incidence of delirium (9% vs. 7.5%, P = .747) were similar between both groups. Sedation with dexmedetomidine resulted in a significant reduction in time on mechanical ventilation. However, no difference was seen in ICU or hospital LOS, incidence of delirium, or mortality.

Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery

“…Recent researches indicate that providing "analgesic priority" treatment program can effectively improve the patient's comfort for the ICU patients [9][10][11][12]. Compared with the traditional sedative treatment, this treatment is beneficial for reducing the patient's stay in the ICU [13]. Therefore, in our study, patients of the two groups were both treated with opioid analgesics and continuous perfused analgesia with hydromorphone, and then, sedation is achieved with midazolam and dexmedetomidine.…”

Comparison of Cognitive Impairments After Intensive Care Unit Sedation Using Dexmedetomidine and Propofol Among Older Patients

“…The benefits of propofol include reduced time in the ICU, duration of mechanical ventilation, and incidence of delirium compared with benzodiazepines sedations . Dexmedetomidine was approved in 1999 by the US Food and Drug Administration for sedation in mechanically ventilated patients during the first 24 hours and in nonintubated patients before and/or during surgical or nonsurgical procedures …”

“…15,17 Dexmedetomidine was approved in 1999 by the US Food and Drug Administration for sedation in mechanically ventilated patients during the first 24 hours and in nonintubated patients before and/or during surgical or nonsurgical procedures. 18 Although the impact of treatments in the ICU on cognitive functioning is increasingly recognized, 19 relatively few published studies have investigated the impacts of sedation medicine on patients discharged from the ICU. Our research showed for the first time that dexmedetomidine and propofol demonstrated different levels of cognitive intervention on the elderly patients discharged from the ICU.…”

Propofol - Remifentanil Versus Midazolam - Fentanyl in Coronary Artery Bypass Graft Surgery and Intensive Care Unit

“…Goals of anesthesia for coronary artery bypass graft (CABG) surgery include hypnosis, hemodynamic stability, neurohumoral stress ablation 4 and may include early tracheal extubation 5 . Fasttrack cardiac surgery is partly dependent on smaller-dose opioid regimens and although these may be associated with increased hemodynamic responses during surgery, there is no apparent increased risk of complications 5 .…”

“…Fasttrack cardiac surgery is partly dependent on smaller-dose opioid regimens and although these may be associated with increased hemodynamic responses during surgery, there is no apparent increased risk of complications 5 .…”