Perioperative Sedation in Mechanically Ventilated Cardiac Surgery Patients With Dexmedetomidine-Based Versus Propofol-Based Regimens

Sedative agents used during cardiac surgery can influence the patient's time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium. This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions...

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Published in:The Annals of pharmacotherapy Vol. 53; no. 1; p. 5
Main Authors: Chuich, Taylor, Cropsey, Christopher Lewis, Shi, Yaping, Johnson, Daniel, Shotwell, Matthew S, Henson, Christopher Patrick
Format: Journal Article
Language:English
Published: United States 01.01.2019
Subjects:
Aged
Cardiac Surgical Procedures - methods
Dexmedetomidine - pharmacology
Dexmedetomidine - therapeutic use
Female
Humans
Hypnotics and Sedatives - pharmacology
Hypnotics and Sedatives - therapeutic use
Male
Middle Aged
Propofol - pharmacology
Propofol - therapeutic use
Respiration, Artificial - methods
Retrospective Studies
critical care
cardiology
anesthesia
ISSN:1542-6270, 1542-6270
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Abstract Sedative agents used during cardiac surgery can influence the patient's time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium. This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions. This 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively. The primary outcome was time to extubation. The secondary outcomes were ICU and hospital length of stay and incidence of delirium. Use of dexmedetomidine (n = 69) as an intraoperative and postoperative sedative as opposed to propofol (n = 209) was significantly associated with increased likelihood of extubation (ie, shorter time to extubation; hazard ratio = 1.63, 95% CI = 1.21-2.19, P = 0.001). There was no significant association between use of dexmedetomidine and ICU discharge ( P = 0.99), hospital discharge ( P = 0.52), and incidence of delirium ( P = 0.27) after adjusting for other covariates. Conclusion and Relevance: Dexmedetomidine increased the likelihood of extubation when compared with propofol, with no increase in ICU or hospital length of stay or incidence of delirium. Our study is unique in that there was no crossover between patients who received dexmedetomidine and propofol infusions intraoperatively and postoperatively Dexmedetomidine-based regimens could serve as a suitable alternative to propofol-based regimens for fast-track extubation.
AbstractList Sedative agents used during cardiac surgery can influence the patient's time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium.BACKGROUNDSedative agents used during cardiac surgery can influence the patient's time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium.This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions.OBJECTIVEThis study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions.This 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively. The primary outcome was time to extubation. The secondary outcomes were ICU and hospital length of stay and incidence of delirium.METHODSThis 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively. The primary outcome was time to extubation. The secondary outcomes were ICU and hospital length of stay and incidence of delirium.Use of dexmedetomidine (n = 69) as an intraoperative and postoperative sedative as opposed to propofol (n = 209) was significantly associated with increased likelihood of extubation (ie, shorter time to extubation; hazard ratio = 1.63, 95% CI = 1.21-2.19, P = 0.001). There was no significant association between use of dexmedetomidine and ICU discharge ( P = 0.99), hospital discharge ( P = 0.52), and incidence of delirium ( P = 0.27) after adjusting for other covariates. Conclusion and Relevance: Dexmedetomidine increased the likelihood of extubation when compared with propofol, with no increase in ICU or hospital length of stay or incidence of delirium. Our study is unique in that there was no crossover between patients who received dexmedetomidine and propofol infusions intraoperatively and postoperatively Dexmedetomidine-based regimens could serve as a suitable alternative to propofol-based regimens for fast-track extubation.RESULTSUse of dexmedetomidine (n = 69) as an intraoperative and postoperative sedative as opposed to propofol (n = 209) was significantly associated with increased likelihood of extubation (ie, shorter time to extubation; hazard ratio = 1.63, 95% CI = 1.21-2.19, P = 0.001). There was no significant association between use of dexmedetomidine and ICU discharge ( P = 0.99), hospital discharge ( P = 0.52), and incidence of delirium ( P = 0.27) after adjusting for other covariates. Conclusion and Relevance: Dexmedetomidine increased the likelihood of extubation when compared with propofol, with no increase in ICU or hospital length of stay or incidence of delirium. Our study is unique in that there was no crossover between patients who received dexmedetomidine and propofol infusions intraoperatively and postoperatively Dexmedetomidine-based regimens could serve as a suitable alternative to propofol-based regimens for fast-track extubation.
Sedative agents used during cardiac surgery can influence the patient's time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium. This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions. This 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively. The primary outcome was time to extubation. The secondary outcomes were ICU and hospital length of stay and incidence of delirium. Use of dexmedetomidine (n = 69) as an intraoperative and postoperative sedative as opposed to propofol (n = 209) was significantly associated with increased likelihood of extubation (ie, shorter time to extubation; hazard ratio = 1.63, 95% CI = 1.21-2.19, P = 0.001). There was no significant association between use of dexmedetomidine and ICU discharge ( P = 0.99), hospital discharge ( P = 0.52), and incidence of delirium ( P = 0.27) after adjusting for other covariates. Conclusion and Relevance: Dexmedetomidine increased the likelihood of extubation when compared with propofol, with no increase in ICU or hospital length of stay or incidence of delirium. Our study is unique in that there was no crossover between patients who received dexmedetomidine and propofol infusions intraoperatively and postoperatively Dexmedetomidine-based regimens could serve as a suitable alternative to propofol-based regimens for fast-track extubation.
Author Johnson, Daniel
Shi, Yaping
Cropsey, Christopher Lewis
Chuich, Taylor
Henson, Christopher Patrick
Shotwell, Matthew S
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  organization: 1 Vanderbilt University Medical Center, Nashville, TN, USA
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crossref_primary_10_1155_2021_1990838
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Snippet Sedative agents used during cardiac surgery can influence the patient's time to extubation, intensive care unit (ICU) and hospital length of stay, and...
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SubjectTerms Aged
Cardiac Surgical Procedures - methods
Dexmedetomidine - pharmacology
Dexmedetomidine - therapeutic use
Female
Humans
Hypnotics and Sedatives - pharmacology
Hypnotics and Sedatives - therapeutic use
Male
Middle Aged
Propofol - pharmacology
Propofol - therapeutic use
Respiration, Artificial - methods
Retrospective Studies
Title Perioperative Sedation in Mechanically Ventilated Cardiac Surgery Patients With Dexmedetomidine-Based Versus Propofol-Based Regimens
URI https://www.ncbi.nlm.nih.gov/pubmed/30066581
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