Comparing dexmedetomidine and propofol for sedation and hemodynamic stability in cardio-thoracic intensive care unit for patients following off-pump coronary artery bypass graft surgery

Vasant P. Patil; Jacob Abraham; Grace M. George

doi:10.18203/2319-2003.ijbcp20210085

Authors

Vasant P. Patil Department of Cardiac Anaesthesia, Lisie heart institutions, Lisie Hospital, Kochi, Kerala
Jacob Abraham Department of Cardiac Anaesthesia, Lisie heart institutions, Lisie Hospital, Kochi, Kerala
Grace M. George Department of Cardiac Anaesthesia, Lisie heart institutions, Lisie Hospital, Kochi, Kerala

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20210085

Keywords:

Sedation, Analgesia, Hemodynamic, Intensive care unit, Off pump coronary artery bypass

Abstract

Background: Most patients in intensive care unit (ICU) require both sedation and analgesia to encourage natural sleep, facilitate assisted ventilation and modulate physiologic response to stress. The ideal sedative after Coronary artery bypass grafting (CABG) should have rapid onset, immediate resolution of both pain and anxiety, promote cardiac and respiratory stability, maintain a reusability during sedation, allow rapid recovery after discontinuation, and attenuate the cardiovascular, neuroendocrine, and inflammatory response. All these properties may improve outcome in cardiac patients after CABG.

Methods: Setting-cardiac ICU. A prospective, randomised, single blind study including 60 patients divided into 2 groups. Data collection tools-study proforma and Ramsay sedation scale (RSS). Data analysed using science and statistical packaged (SPSS) version 20, independent sample `t` test, chi-square test, analysis of variance (ANOVA) and p value ≤0.05 was considered statistically significant.

Results: Sedation levels and length of stay of patients on ventilator were comparable in both groups, however, analgesic requirement was significantly less in dexmedetomidine group. Dexmedetomidine group showed significantly lower heart rates compared to propofol group.

Conclusions: Dexmedetomidine and propofol are safe sedative agents during mechanical ventilation in ICU for patients undergoing off pump coronary artery bypass (OPCAB). There is more than 50% reduction in analgesic requirement and a significant reduction in heart rate in dexmedetomidine sedated patients.

Metrics

Metrics Loading ...

References

Talke P, Chean R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P et al. The hemodynamics and adrenergic effects of perioperative dexmedetomidine infusions after vascular surgery. Anesth Analg. 2000;90:834-45.

Herr DL, Sum-Ping, England M. ICU sedation after coronary artery bypass graft surgery: Dexmedetomidine-based versus Propofol-based sedation regimens. J Cardiothoracic vascular Anesthesia. 2003;17(5):576-84.

Maze M, Scheinin M. Molecular pharmacology of α2-adrenergic receptors. Anaesth Pharmacol. 1993;1:233-7.

Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C et al. Preliminary UK experience of dexmetedomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:1136-42.

Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000;4:302-8.

Aitkenhead AR, Pepperman ML, Willatts SM. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet. 1989;2:704-9.

Barr J, Donner A. Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit. Crit Care Clin. 1995;11:827-47.

Mittnacht AJC, Weiner M, London MJ, Kaplan JA. Anesthesia for Myocardial Revascularization. Kaplan’s Cardiac Anesthesia: The Echo Era. 6th edition. Missouri: Saunders. 2011;550-3.

Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: Patient and clinician perceptions. Br J Anaesth. 2001;87:684-90.

Triltsch AE, Welte M, Homeyer PV, Grobe J, Genahr A, Moshirzadeh M et al. Spies. Bispectral index-guided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind, placebo-controlled phase II study. Crit Care Med. 2002;30:1007-14.

Ralib A, Ali S, Ahmad MN, Ghazali ZM, Mohamad NAN. A Compartive study of dexmedetomidine and propofol for sedation in the Cardiothoracic unit. Int. Med J. 2007;(6):2.

Belleville JP, Ward DS, Bloor BC. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiol. 1992;77:1125-33.

De Lemos J, Tweeddale M, Chittock D. Measuring quality of sedation in adult mechanically ventilated critically ill patients. The Vancouver Interaction and Calmness Scale Sedation Focus Group. J Clin Epidemiol. 2000;53:908-19.

Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R. Controlled Sedation with alpaxalone-alphadolone. BMJ. 1974;2:656-9.

Khan ZP, Ferguson CN, Jones RM. Alpha2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia. 1999;54:146-65.

Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiol. 2000;93:1345-9.

Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. BUMC Preceding. 2001;14:13-21.

Hughes MA, Glass PS, Jacobs JR. Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiol. 1992;76:334-41.

Reves JG, Glass PSA, Lubarsky DA, McEvoy MD, Martinez-Ruiz R. Intravenous Anaesthetics. Miller's Anesthesia 7th Edition. Philadelphia: Churchill Livingstone. 2010;720-8.

Riker RR, Fraser GL. Altering intensive care sedation paradigms to improve patient outcomes. Rev Crit Care Clin. 2009;25:527-38, viii-ix.

Elbaradie S, Mahalawy FHEL, Solyman AH. Dexmedetomidine vs. Propofol for Short-Term Sedation of Postoperative Mechanically Ventilated Patients. J Egy Nat Cancer Inst. 2004;16(3):153-8.

Hall JE, Uhrich TD, Barney JA. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699-705.

Khalil AR, Hanafy MA, El-Istekawy SM. The use of injectable paracetamol as an adjunt for postoperative pain management after off-pump fast-track coronary artery bypass grafting surgery. J Egy Soc Cardiothoracic Surg. 2005;13(1-2):25-33.

Mondello E, Siliotti R, Noto G, Cuzzero E, Scollo G, Trimaachi G et al. Bispectral index in ICU: correlation with Ramsay score on assessment of sedation level. J Clin Monitoring. 2002;17:271-77.

Snellen F, Lauwers P, Demeyere R, Byttebier G, Van Aken H. The use of midazolam versus propofol for short-term sedation following coronary artery bypass grafting. Intensive Care Med. 1990;16:312-6.

Cheng DC, Karski J, Peniston C, Asokumar B, Raveendran G, Carroll J et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: A prospective randomized controlled trial. J Thorac Cardiovasc Surg. 1996;112:755.

Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC. A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Anesthesiol. 2003;99:982.

Hawkes CA, Dhileepan S, Foxcroft D. Early extubation for adult cardiac surgical patients, Cochrane Database Syst Rev 4: systematic review and meta-analysis of randomised controlled trials. 2003:CD003587.

Sebel PS, Lowdon JD. Propofol: A new intravenous anesthetic. Anesthesiol. 1989;71:260-77.

Shehabi Y, Botha JA, Ernest D, Freebairn RC, Reade M, Roberts BL et al. Clinical application, the use of dexmedetomidine in intensive care sedation. Review article. Crit Care Shock. 2010;13:40-50.

Nishina K, Mikawa K, Uesugi T, Obara H, Maekawa M, Kamae I et al. Efficacy of clonidine for prevention of perioperative myocardial ischemia: A critical appraisal and meta-analysis of the literature. Anesthesiol. 2002;96:323-9.