Propofol-Based Versus Dexmedetomidine-Based Sedation in Cardiac Surgery Patients

• Published in: Journal of cardiothoracic and vascular anesthesia 2013-12, Vol.27 (6), p.1289-1294
• Main Authors: Curtis, James A., PharmD, BCPS, Hollinger, Meredith K., PharmD, BCPS, Jain, Harsh B., MD
• Format: Article
• Language: English
• Subjects: Aged; Airway Extubation; Airway Management; Anesthesia & Perioperative Care; cardiac surgery; Cardiac Surgical Procedures - economics; Cardiac Surgical Procedures - methods; Cardiopulmonary Bypass; Conscious Sedation - methods; costs; Costs and Cost Analysis; Critical Care; Databases, Factual; Dexmedetomidine; early extubation; fast track; Female; Hospital Mortality; Humans; Hypnotics and Sedatives; length of stay; Longevity; Male; mortality; outcomes; Propofol; Respiration, Artificial; Retrospective Studies; sedation; Socioeconomic Factors
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.03.022

Objectives To evaluate the effects of propofol-based and dexmedetomidine-based sedation regimens on achieving early extubation, length of stay (LOS), intensive care length of stay (ICU-LOS), total hospital costs, and mortality rates in cardiac surgery patients. Design Twenty-three-month retrospective analysis. Setting Single center, 907 bed community teaching hospital. Participants Five hundred eighty-two patients ≥18 years of age who received propofol-based or dexmedetomidine-based sedation after cardiac valve or coronary artery bypass grafting (CABG) surgery and who did not undergo prolonged surgery (≤8 hours). Intervention Retrospective review of medical records. Measurements and Main Results Baseline characteristics (eg, age, sex, comorbidities) and outcomes (eg, achievement of early extubation, LOS, ICU-LOS, total hospital costs, pharmacy costs) were collected. Early extubation was achieved more frequently in the dexmedetomidine group when compared with the propofol group (68.7% v 58.1%, p = 0.008). The mean postoperative time to extubation and hospital LOS were shorter in the dexmedetomidine group when compared with the propofol group (8.8 v 12.8 hours, p = 0.026) and (181.9 v 221.3 hours, p = 0.001), respectively. There was a reduced ICU-LOS in the dexmedetomidine group compared with the propofol group that did not reach statistical significance (43.9 v 52.5 hours, p = 0.067). Average total hospital charges for the dexmedetomidine group were approximately $4000.00 less than the propofol group. Conclusions Dexmedetomidine-based sedation resulted in achievement of early extubation more frequently than propofol-based sedation. Mean postoperative time to extubation and average hospital LOS were shorter with dexmedetomidine-based sedation and met a statistical level of significance. There was no difference in ICU-LOS or in-hospital mortality between the two groups. Total hospital charges were similar, although slightly higher in the propofol group.