ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens.
OBJECTIVE
To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU).


METHODS
Randomized, open label.


METHODS
Twenty-five centers in the United States and Canada.


METHODS
Two hundred ninety-five adults undergoing CABG surgery.


METHODS
At sternal closure, patients in group A received 1.0 microg/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 microg/kg/h to maintain a Ramsay sedation score > or =3 during assisted ventilation and > or =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.


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 beta-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).


CONCLUSIONS
Dexmedetomidine provided safe and effective sedation for post-CABG surgical patients and significantly reduced the use of analgesics, beta-blockers, antiemetics, epinephrine, and diuretics.
Washington Hospital Center, Washington, DC 2010, USA. Daniel.L.Herr@medstar.net
Daniel L
DL
Herr
S T John
ST
Sum-Ping
Michael
M
England
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D001806:Blood Urea Nitrogen; D002170:Canada / Q000453:epidemiology; D016292:Procedural Sedation; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D020927:Dexmedetomidine; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives; D015994:Incidence; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009020:Morphine; D011182:Postoperative Care; D011183:Postoperative Complications / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology; D015742:Propofol; D012121:Respiration, Artificial; D013599:Systole / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use; D005723:gamma-Glutamyltransferase / Q000097:blood
D000319:Adrenergic beta-Antagonists; D000701:Analgesics, Opioid; D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D004232:Diuretics; D006993:Hypnotics and Sedatives; D014665:Vasodilator Agents; D020927:Dexmedetomidine; D009020:Morphine; D005723:gamma-Glutamyltransferase; D015742:Propofol