Impact of dexmedetomidine on analgesic requirements in patients after cardiac surgery in a fast-track recovery room setting.
OBJECTIVE
To compare postoperative opioid requirements in patients who received dexmedetomidine versus propofol after cardiac surgery.


METHODS
Retrospective cohort study.


METHODS
Large, community teaching hospital that uses a fast-track cardiovascular recovery unit (CVRU) model.


METHODS
One hundred adults who underwent coronary artery bypass graft surgery and/or valvular surgery, and who received either dexmedetomidine (50 patients) or propofol (50 patients) for perioperative sedation.


RESULTS
Patients were matched according to surgery type and left ventricular ejection fraction. Opioid requirements were assessed over two time intervals: from arrival in the CVRU to discontinuation of the sedative infusion, and from CVRU arrival to CVRU discharge, up to a maximum of 72 hours if admission to the intensive care unit was necessary. All postoperative opioid doses were converted to morphine equivalents. Length of mechanical ventilation, quality of sedation, adverse drug events, and sedation-related costs were determined. Opioid requirements were significantly lower during the sedative infusion period for dexmedetomidine-treated patients than for propofol-treated patients (median [range] 0 [0-10 mg] vs 4 mg [0-33 mg], p<0.001), but not through the entire CVRU admission (median [range] 26 mg [0-119 mg] vs 30 mg (0-100 mg], p=0.284). The proportion of patients who did not require opioids during the infusion was significantly higher in the dexmedetomidine group compared with the propofol group (32 [64%] vs 13 [26%], p<0.001). No significant differences were noted between the groups for length of mechanical ventilation, quality of sedation, or adverse events. Sedation-related costs were significantly higher (approximately $50/patient higher) with dexmedetomidine (p<0.001).


CONCLUSIONS
Dexmedetomidine resulted in lower opioid requirements in patients after cardiac surgery versus those receiving propofol, but this did not result in shorter durations of mechanical ventilation, using a fast-track CVRU model.
Barletta
Jeffrey F
JF
Departments of Pharmacy, Spectrum Health, Grand Rapids, Michigan 49503, USA. barletta@spectrum-health.org
Miedema
Sherri L
SL
Wiseman
Douglas
D
Heiser
John C
JC
McAllen
Karen J
KJ
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000379:methods; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods; D020927:Dexmedetomidine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D015742:Propofol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol