title: Sedative efficacy of propofol in patients intubated/ventilated after coronary artery bypass graft surgery.
abstract: BACKGROUND
  Sedation after open heart surgery is important in preventing stress on the heart. The unique sedative features of propofol prompted us to evaluate its potential clinical role in the sedation of post-CABG patients.
  
  
  OBJECTIVE
  To compare propofol-based sedation to midazolam-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU).
  
  
  METHODS
  Fifty patients who were admitted to the ICU after CABG surgery was randomized into two groups to receive sedation with either midazolam or propofol infusions; and additional analgesia was administered if required. Inclusion criteria were as follows: patients 40-60 years old, hemodynamic stability, ejection fraction (EF) more than 40%; exclusion criteria included patients who required intra-aortic balloon pump or inotropic drugs post-bypass. The same protocol of anesthetic medications was used in both groups. Depth of sedation was monitored using the Ramsay sedation score (RSS). Invasive mean arterial pressure (MAP) and heart rate (HR), arterial blood gas (ABG) and ventilatory parameters were monitored continuously after the start of study drug and until the patients were extubated.
  
  
  RESULTS
  The depth of sedation was almost the same in the two groups (RSS=4.5 in midazolam group vs 4.7 in propofol group; P = 0.259) but the total dose of fentanyl in the midazolam group was significantly more than the propofol group (12.5 mg/hr vs 4 mg/hr) (P = 0.0039). No significant differences were found in MAP (P = 0.51) and HR (P = 0.41) between the groups. The mean extubation time in patients sedated with propofol was shorter than those sedated with midazolam (102 ± 27 min vs 245 ± 42 min, respectively; P < 0.05) but the ICU discharge time was not shorter (47.5 hr vs 36.3 hr, respectively; P = 0.24).
  
  
  CONCLUSIONS
  Propofol provided a safe and acceptable sedation for post-CABG surgical patients, significantly reduced the requirement for analgesics, and allowed for more rapid tracheal extubation than midazolam but did not result in earlier ICU discharge.
authors.affiliation: Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Aghdaii
authors.affiliation: Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Frouzan
authors.initials: F
authors.lastname: Yazdanian
authors.affiliation: Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyedeh Zahra
authors.initials: SZ
authors.lastname: Faritus
keywords: Airway Extubation; Analgesics; Coronary Artery Bypass; Deep Sedation; Length of Stay; Midazolam; Propofol