title: Effect of a dexmedetomidine substitution during a nationwide propofol shortage in patients undergoing coronary artery bypass graft surgery.
abstract: OBJECTIVE
  To assess the effect of substituting dexmedetomidine for propofol during a nationwide propofol shortage on postoperative time to extubation and opioid requirements in patients who underwent coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Single-center cardiothoracic intensive care unit (ICU) in a tertiary academic medical center.
  
  
  METHODS
  Seventy adults undergoing isolated, primary, elective CABG who received dexmedetomidine between April 1 and June 30, 2010, during the propofol shortage (35 patients [cases]) or who received propofol between January 1 and March 31, 2010, or between July 1 and September 30, 2010 (35 patients [controls]) for postoperative sedation were included. Patients in the dexmedetomidine group were matched 1:1 to patients in the propofol group based on age, sex, weight, number of vessels bypassed, preoperative ejection fraction, cardiopulmonary bypass time, and aortic cross-clamp time.
  
  
  RESULTS
  The primary outcome consisted of opioid requirements in the first 12 hours after arrival to the ICU in the dexmedetomidine- and propofol-treated patients. Secondary outcomes included the time to extubation (from ICU admission until extubation) and opioid requirements in the first 24 hours. No significant demographic differences were noted between treatment groups. Median opioid requirements in the first 12 hours, as measured by morphine equivalents, were 8.0 mg in the propofol group and 7.0 mg in the dexmedetomidine group (p=0.1). Similarly, at 24 hours, opioid requirements were 16.7 and 17.3 mg in the propofol and dexmedetomidine groups, respectively (p=0.4). The time to extubation demonstrated that patients in the propofol group were extubated at a median of 300 minutes and patients in the dexmedetomidine group were extubated at a median of 318 minutes after ICU arrival (p=0.5).
  
  
  CONCLUSIONS
  No statistically significant differences were noted between the propofol and dexmedetomidine groups when assessing the outcomes of opioid requirements and the time to extubation. A multicenter, prospective, randomized, blinded study is needed to determine the optimal sedative after CABG surgery.
authors.affiliation: Department of Pharmacy, Wake Forest University Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. mreicher@wfubmc.edu.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Reichert
authors.forename: Whitney A
authors.initials: WA
authors.lastname: Jones
authors.forename: Roger L
authors.initials: RL
authors.lastname: Royster
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Slaughter
authors.forename: Neal D
authors.initials: ND
authors.lastname: Kon
authors.forename: Edward H
authors.initials: EH
authors.lastname: Kincaid
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D003422:Critical Care / Q000379:methods; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000600:supply & distribution / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000600:supply & distribution / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol