title: Comparison of dexmedetomidine versus propofol for sedation in mechanically ventilated patients after cardiovascular surgery.
abstract: Many cardiovascular surgeries are fast-tracked to extubation and require short-term sedation. Dexmedetomidine and propofol have very different mechanisms of action and pharmacokinetic profiles that make them attractive sedative agents in this patient population. Recently, there has been increased use of dexmedetomidine in the intensive care unit (ICU), but few studies exist or have been published directly comparing both agents in this setting. We conducted a retrospective cohort study with patients admitted to the ICU after cardiovascular surgery from January through June 2011. Adult patients who underwent coronary artery bypass and/or cardiac valve surgery received either dexmedetomidine or propofol continuous infusion for short-term sedation after cardiovascular surgery. The primary end point was time (hours) on mechanical ventilation after surgery. Secondary end points included ICU length of stay (LOS), hospital LOS, incidence of delirium, and requirement of a second sedative agent. A total of 352 patients met study inclusion criteria, with 33 enrolled in the dexmedetomidine group and 319 in the propofol group. Time on mechanical ventilation was shorter in the dexmedetomidine group (7.4 hours vs. 12.9 hours, P = .042). No difference was seen in ICU or hospital LOS. The need for a second sedative agent to achieve optimal sedation (24% vs. 27%, P = .737) and incidence of delirium (9% vs. 7.5%, P = .747) were similar between both groups. Sedation with dexmedetomidine resulted in a significant reduction in time on mechanical ventilation. However, no difference was seen in ICU or hospital LOS, incidence of delirium, or mortality.
authors.affiliation: University of Houston College of Pharmacy, Houston, Texas ; Houston Methodist Hospital, Houston, Texas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wanat
authors.affiliation: Houston Methodist Hospital, Houston, Texas.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Fitousis
authors.affiliation: Houston Methodist Hospital, Houston, Texas.
authors.forename: Fariedeh
authors.initials: F
authors.lastname: Boston
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas ; Weill Cornell Medical College, New York, New York.
authors.forename: Faisal
authors.initials: F
authors.lastname: Masud
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D003693:Delirium / Q000209:etiology; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007263:Infusions, Parenteral; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
keywords: cardiovascular surgery; delirium; dexmedetomidine; propofol; sedation
references.citation: Ann Pharmacother. 2009 Dec;43(12):2064-74
references.pmid: 19934395
references.citation: Anesthesiology. 2003 Oct;99(4):982-7
references.pmid: 14508335
references.citation: JAMA. 2004 Apr 14;291(14):1753-62
references.pmid: 15082703
references.citation: Curr Pharm Des. 2004;10(29):3639-49
references.pmid: 15579060
references.citation: Crit Care. 2012 May 16;16(3):R84
references.pmid: 22591601
references.citation: Crit Care Med. 2010 Dec;38(12):2311-8
references.pmid: 20838332
references.citation: JAMA. 2009 Feb 4;301(5):489-99
references.pmid: 19188334
references.citation: Pharmacotherapy. 2005 Oct;25(10):1348-52
references.pmid: 16185179
references.citation: Crit Care Med. 2004 Nov;32(11):2254-9
references.pmid: 15640638
references.citation: JAMA. 2007 Dec 12;298(22):2644-53
references.pmid: 18073360
references.citation: Crit Pathw Cardiol. 2010 Dec;9(4):221-6
references.pmid: 21119342
references.citation: Crit Care Med. 2004 Apr;32(4):955-62
references.pmid: 15071384
references.citation: Anesthesiology. 1998 Jun;88(6):1429-33
references.pmid: 9637632
references.citation: Anesthesiol Clin. 2011 Dec;29(4):625-50
references.pmid: 22078913
references.citation: Drug Saf. 2008;31(4):293-303
references.pmid: 18366240
references.citation: J Cardiothorac Vasc Anesth. 2003 Oct;17(5):576-84
references.pmid: 14579210
references.citation: Crit Care Med. 2008 Feb;36(2):427-33
references.pmid: 18091554
references.citation: J Intensive Care Med. 2003 Jan-Feb;18(1):29-41
references.pmid: 15189665
references.citation: Crit Care Clin. 2009 Jul;25(3):431-49, vii
references.pmid: 19576523
references.citation: Crit Care. 2008;12 Suppl 3:S6
references.pmid: 18495057
references.citation: Am J Crit Care. 2008 Nov;17(6):555-65; quiz 566
references.pmid: 18978240
references.citation: Am J Health Syst Pharm. 2007 Jan 1;64(1):37-44
references.pmid: 17189578
references.citation: Pharmacotherapy. 2009 Dec;29(12):1427-32
references.pmid: 19947802
references.citation: Pharmacotherapy. 2008 Feb;28(2):250-8
references.pmid: 18225970
references.citation: Crit Care. 2009;13(5):R169
references.pmid: 19874582
references.citation: Med Care. 1998 Jan;36(1):8-27
references.pmid: 9431328
references.citation: J Trauma. 2011 Nov;71(5):1164-71
references.pmid: 21502875
references.citation: Paediatr Anaesth. 2005 Nov;15(11):1006-8
references.pmid: 16238566
references.citation: Crit Care Med. 2002 Jan;30(1):119-41
references.pmid: 11902253
references.citation: Crit Care Med. 2010 Feb;38(2):497-503
references.pmid: 19789442
references.citation: Pharmacotherapy. 2011 Jul;31(7):673-7
references.pmid: 21923454