title: Dexmedetomidine Versus Propofol Sedation Improves Sublingual Microcirculation After Cardiac Surgery: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To compare the effects of dexmedetomidine and propofol on sublingual microcirculation in patients after cardiac surgery.
  
  
  METHODS
  A prospective, randomized, single-blind study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Adult patients undergoing elective valve surgery with cardiopulmonary bypass.
  
  
  METHODS
  On arrival in the intensive care unit (ICU), patients were assigned randomly to receive either dexmedetomidine (0.2-1.5 μg/kg/h) or propofol (5-50 μg/kg/min) with open-label titration to a target Richmond Agitation-Sedation Scale of 0 to -3.
  
  
  RESULTS
  Sublingual microcirculation was recorded using sidestream dark-field imaging at ICU admission (baseline [T1]) and 4 hours (T2) and 24 hours after ICU admission (T3). At T2, median changes in perfused small-vessel density and the De Backer score from baseline were significantly greater in the dexmedetomidine group (n = 29) than in the propofol group (n = 32) (1.3 v 0 mm/mm2, p = 0.025; 0.9 v -0.1/mm, p = 0.005, respectively); median changes in small-vessel density and the proportion of perfused small vessels from baseline also tended to be higher in the dexmedetomidine group compared with the propofol group (1.0 v -0.1 mm/mm2, p = 0.050; 2.1% v 0.5%, p = 0.062, respectively). At T3, there still was a trend toward greater improvements in the small-vessel density, proportion of perfused small-vessels, perfused small-vessel density, and De Backer score from baseline in the dexmedetomidine group than in the propofol group.
  
  
  CONCLUSIONS
  This trial demonstrated that dexmedetomidine sedation may be better able to improve microcirculation in cardiac surgery patients during the early postoperative period compared with propofol.
authors: Anesthesiology and Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Xu
authors: X
authors: Liu
authors: Anesthesiology and Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Kai
authors: K
authors: Zhang
authors: Anesthesiology and Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Wei
authors: W
authors: Wang
authors: Anesthesiology and Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Guohao
authors: G
authors: Xie
authors: Anesthesiology and Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Baoli
authors: B
authors: Cheng
authors: Anesthesiology and Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Yan
authors: Y
authors: Wang
authors: Anesthesiology, Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Yaoqin
authors: Y
authors: Hu
authors: Anesthesiology and Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. Electronic address: xiangming_fang@163.com.
authors: Xiangming
authors: X
authors: Fang
mesh_terms: D016292:Procedural Sedation / Q000379:methods; D003422:Critical Care / Q000379:methods; D020927:Dexmedetomidine / Q000494:pharmacology*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D011182:Postoperative Care / Q000379:methods; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D016037:Single-Blind Method
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
keywords: cardiac surgery; dexmedetomidine; microcirculation; propofol; sedation