title: Propofol-based versus dexmedetomidine-based sedation in cardiac surgery patients.
abstract: OBJECTIVE
  To evaluate the effects of propofol-based and dexmedetomidine-based sedation regimens on achieving early extubation, length of stay (LOS), intensive care length of stay (ICU-LOS), total hospital costs, and mortality rates in cardiac surgery patients.
  
  
  METHODS
  Twenty-three-month retrospective analysis.
  
  
  METHODS
  Single center, 907 bed community teaching hospital.
  
  
  METHODS
  Five hundred eighty-two patients ≥ 18 years of age who received propofol-based or dexmedetomidine-based sedation after cardiac valve or coronary artery bypass grafting (CABG) surgery and who did not undergo prolonged surgery (≤ 8 hours).
  
  
  METHODS
  Retrospective review of medical records.
  
  
  RESULTS
  Baseline characteristics (eg, age, sex, comorbidities) and outcomes (eg, achievement of early extubation, LOS, ICU-LOS, total hospital costs, pharmacy costs) were collected. Early extubation was achieved more frequently in the dexmedetomidine group when compared with the propofol group (68.7% v 58.1%, p = 0.008). The mean postoperative time to extubation and hospital LOS were shorter in the dexmedetomidine group when compared with the propofol group (8.8 v 12.8 hours, p = 0.026) and (181.9 v 221.3 hours, p = 0.001), respectively. There was a reduced ICU-LOS in the dexmedetomidine group compared with the propofol group that did not reach statistical significance (43.9 v 52.5 hours, p = 0.067). Average total hospital charges for the dexmedetomidine group were approximately $4000.00 less than the propofol group.
  
  
  CONCLUSIONS
  Dexmedetomidine-based sedation resulted in achievement of early extubation more frequently than propofol-based sedation. Mean postoperative time to extubation and average hospital LOS were shorter with dexmedetomidine-based sedation and met a statistical level of significance. There was no difference in ICU-LOS or in-hospital mortality between the two groups. Total hospital charges were similar, although slightly higher in the propofol group.
authors.affiliation: Department of Pharmacy, Christiana Care Health System, Wilmington, Delaware.
authors.forename: James A
authors.initials: JA
authors.lastname: Curtis
authors.forename: Meredith K
authors.initials: MK
authors.lastname: Hollinger
authors.forename: Harsh B
authors.initials: HB
authors.lastname: Jain
mesh_terms: D000368:Aged; D060666:Airway Extubation; D058109:Airway Management; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods*; D002315:Cardiopulmonary Bypass; D016292:Procedural Sedation / Q000379:methods*; D003365:Costs and Cost Analysis; D003422:Critical Care; D016208:Databases, Factual; D020927:Dexmedetomidine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives; D008136:Longevity; D008297:Male; D015742:Propofol; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
keywords: cardiac surgery; costs; dexmedetomidine; early extubation; fast track; length of stay; mortality; outcomes; propofol; sedation