Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation.
OBJECTIVE
Dexmedetomidine (DEX) may provide a sedation level that enables sleep and communication, with less amnesia and pain medication requirements, during mechanical ventilation. Our study directly assessed patient-perceived satisfaction with coronary artery bypass graft surgery after administration of DEX or propofol for intensive care unit (ICU) sedation.


METHODS
Prospective, randomized clinical study with subsequent questionnaire administration.


METHODS
Tertiary care surgical ICU.


METHODS
A total of 89 adult, nonemergent, coronary artery bypass graft patients with an expected length of intubation of <24 hrs.


METHODS
Patients were randomized to either DEX or propofol; drug administration was performed via standardized anesthesia and nursing protocols.


METHODS
Patients reported perceptions of their ICU experience after mechanical ventilation with a modified numerical-scale Hewitt questionnaire, validated specifically for ICU patients. Patients were questioned regarding awareness, recall, generalized comfort, level of pain, ability to interact with healthcare providers and family, feelings of agitation and anxiety, perceived ease of extubation, ability to sleep or rest, and satisfaction with ICU experience.


RESULTS
Groups were well matched at baseline, with a mean +/- sd age of 63.0 +/- 10.4 yrs and weight of 88.7 +/- 16.7 kg. No difference was observed for length of surgery, length of intubation, or ICU stay (p > .05). DEX patients perceived a shorter length of intubation (p = .044). A deeper sedation level was found in the propofol group (p = .021), with similar morphine and midazolam requirements (p = .317). Patient-rated level of overall awareness as a marker of amnesia did not differ between groups (p = .653). The ability to rest or sleep trended toward significance favoring propofol (p = .051). On evaluation of questionnaire ratings, DEX patients expressed more discomfort (p = .046), pain (p = .096), and sleeping difficulty (p = .036). Similar comfort levels were reported during extubation (p = .179).


CONCLUSIONS
Despite theoretical advantages of DEX to improve overall patient satisfaction, the two agents provide similar responses to amnesia and pain control. According to our findings, DEX does not seem to have any advantage compared with propofol for short-term sedation after coronary artery bypass graft surgery.
Corbett
Stephanie Mallow
SM
Divisions of Trauma/Critical Care, Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
Rebuck
Jill A
JA
Greene
Christopher M
CM
Callas
Peter W
PW
Neale
Bruce W
BW
Healey
Mark A
MA
Leavitt
Bruce J
BJ
D001026:Coronary Artery Bypass; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D015742:Propofol / Q000627:therapeutic use*; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol