ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens

• Published in: Journal of cardiothoracic and vascular anesthesia 2003-10, Vol.17 (5), p.576-584
• Main Authors: Herr, Daniel L, Sum-Ping, S.T.John, England, Michael
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; alpha 2-adrenoceptors; Analgesics; Analgesics, Opioid; Anti-Arrhythmia Agents - therapeutic use; Biological and medical sciences; Biomarkers - blood; Blood Pressure - physiology; Blood Urea Nitrogen; Canada - epidemiology; cardiac artery bypass graft; Conscious Sedation; Coronary Artery Bypass; Coronary Artery Disease - blood; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Dexmedetomidine; Diuretics - therapeutic use; Female; gamma-Glutamyltransferase - blood; Heart Rate - physiology; Humans; Hypnotics and Sedatives; imidazoles; Incidence; Infusions, Intravenous; Intensive Care Units; Male; Medical sciences; Middle Aged; Morphine; Neuropharmacology; Pharmacology. Drug treatments; Postoperative Care; Postoperative Complications - chemically induced; Postoperative Complications - drug therapy; Postoperative Complications - physiopathology; Propofol; Respiration, Artificial; sedation; sympatholysis; Systole - physiology; Time Factors; Treatment Outcome; United States - epidemiology; Vasodilator Agents - therapeutic use
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1016/S1053-0770(03)00200-3

Objective: To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). Design: Randomized, open label. Setting: Twenty-five centers in the United States and Canada. Participants: Two hundred ninety-five adults undergoing CABG surgery. Interventions: At sternal closure, patients in group A received 1.0 μg/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 μg/kg/h to maintain a Ramsay sedation score ≥3 during assisted ventilation and ≥2 after extubation. Patients could be given propofol for additional sedation if necessary; group B patients received propofol-based care according to each investigator’s standard practice. Measurements and main results: Mean sedation levels were within target ranges in both groups. Mean times to weaning and extubation were similar, although fewer dexmedetomidine patients remained on the ventilator beyond 8 hours. Morphine use was significantly reduced in the dexmedetomidine group. Only 28% of the dexmedetomidine patients required morphine for pain relief while ventilated versus 69% of propofol-based patients ( p < 0.001). Propofol patients required 4 times the mean dose of morphine while in the ICU. Mean blood pressure increased initially in both groups, then decreased to 3 mmHg below baseline in dexmedetomidine patients; mean arterial pressure remained at 9 mmHg above baseline in propofol patients. No ventricular tachycardia occurred in the dexmedetomidine-sedated patients compared with 5% of the propofol patients ( p = 0.007). Respiratory rates and blood gases were similar. Fewer dexmedetomidine patients received β-blockers ( p = 0.014), antiemetics ( p = 0.015), nonsteroidal anti-inflammatory drugs ( p < 0.001), epinephrine ( p = 0.030), or high-dose diuretics ( p < 0.001). Conclusion: Dexmedetomidine provided safe and effective sedation for post-CABG surgical patients and significantly reduced the use of analgesics, β-blockers, antiemetics, epinephrine, and diuretics.