ICU Sedation After Coronary Artery Bypass Graft Surgery: Dexmedetomidine-Based Versus Propofol-Based Sedation Regimens

Daniel L. Herr, S. T John Sum-Ping, Michael England

Research output: Contribution to journalArticle

228 Citations (Scopus)

Abstract

Objective: To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). Design: Randomized, open label. Setting: Twenty-five centers in the United States and Canada. Participants: Two hundred ninety-five adults undergoing CABG surgery. Interventions: At sternal closure, patients in group A received 1.0 μg/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 μg/kg/h to maintain a Ramsay sedation score ≥3 during assisted ventilation and ≥2 after extubation. Patients could be given propofol for additional sedation if necessary; group B patients received propofol-based care according to each investigator's standard practice. Measurements and Main Results: Mean sedation levels were within target ranges in both groups. Mean times to weaning and extubation were similar, although fewer dexmedetomidine patients remained on the ventilator beyond 8 hours. Morphine use was significantly reduced in the dexmedetomidine group. Only 28% of the dexmedetomidine patients required morphine for pain relief while ventilated versus 69% of propofol-based patients (p < 0.001). Propofol patients required 4 times the mean dose of morphine while in the ICU. Mean blood pressure increased initially in both groups, then decreased to 3 mmHg below baseline in dexmedetomidine patients; mean arterial pressure remained at 9 mmHg above baseline in propofol patients. No ventricular tachycardia occurred in the dexmedetomidine-sedated patients compared with 5% of the propofol patients (p = 0.007). Respiratory rates and blood gases were similar. Fewer dexmedetomidine patients received β-blockers (p = 0.014), antiemetics (p = 0.015), nonsteroidal anti-inflammatory drugs (p < 0.001), epinephrine (p = 0.030), or high-dose diuretics (p < 0.001). Conclusion: Dexmedetomidine provided safe and effective sedation for post-CABG surgical patients and significantly reduced the use of analgesics, β-blockers, antiemetics, epinephrine, and diuretics.

Original languageEnglish (US)
Pages (from-to)576-584
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume17
Issue number5
DOIs
StatePublished - Oct 2003

Fingerprint

Dexmedetomidine
Propofol
Coronary Artery Bypass
Intensive Care Units
Transplants
Morphine
Antiemetics
Diuretics
Epinephrine
Mechanical Ventilators
Ventricular Tachycardia
Respiratory Rate
Weaning
Canada
Ventilation

Keywords

  • Alpha-adrenoceptors
  • Cardiac artery bypass graft
  • Imidazoles
  • Sedation
  • Sympatholysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

ICU Sedation After Coronary Artery Bypass Graft Surgery : Dexmedetomidine-Based Versus Propofol-Based Sedation Regimens. / Herr, Daniel L.; Sum-Ping, S. T John; England, Michael.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 17, No. 5, 10.2003, p. 576-584.

Research output: Contribution to journalArticle

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abstract = "Objective: To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). Design: Randomized, open label. Setting: Twenty-five centers in the United States and Canada. Participants: Two hundred ninety-five adults undergoing CABG surgery. Interventions: At sternal closure, patients in group A received 1.0 μg/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 μg/kg/h to maintain a Ramsay sedation score ≥3 during assisted ventilation and ≥2 after extubation. Patients could be given propofol for additional sedation if necessary; group B patients received propofol-based care according to each investigator's standard practice. Measurements and Main Results: Mean sedation levels were within target ranges in both groups. Mean times to weaning and extubation were similar, although fewer dexmedetomidine patients remained on the ventilator beyond 8 hours. Morphine use was significantly reduced in the dexmedetomidine group. Only 28{\%} of the dexmedetomidine patients required morphine for pain relief while ventilated versus 69{\%} of propofol-based patients (p < 0.001). Propofol patients required 4 times the mean dose of morphine while in the ICU. Mean blood pressure increased initially in both groups, then decreased to 3 mmHg below baseline in dexmedetomidine patients; mean arterial pressure remained at 9 mmHg above baseline in propofol patients. No ventricular tachycardia occurred in the dexmedetomidine-sedated patients compared with 5{\%} of the propofol patients (p = 0.007). Respiratory rates and blood gases were similar. Fewer dexmedetomidine patients received β-blockers (p = 0.014), antiemetics (p = 0.015), nonsteroidal anti-inflammatory drugs (p < 0.001), epinephrine (p = 0.030), or high-dose diuretics (p < 0.001). Conclusion: Dexmedetomidine provided safe and effective sedation for post-CABG surgical patients and significantly reduced the use of analgesics, β-blockers, antiemetics, epinephrine, and diuretics.",
keywords = "Alpha-adrenoceptors, Cardiac artery bypass graft, Imidazoles, Sedation, Sympatholysis",
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T1 - ICU Sedation After Coronary Artery Bypass Graft Surgery

T2 - Dexmedetomidine-Based Versus Propofol-Based Sedation Regimens

AU - Herr, Daniel L.

AU - Sum-Ping, S. T John

AU - England, Michael

PY - 2003/10

Y1 - 2003/10

N2 - Objective: To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). Design: Randomized, open label. Setting: Twenty-five centers in the United States and Canada. Participants: Two hundred ninety-five adults undergoing CABG surgery. Interventions: At sternal closure, patients in group A received 1.0 μg/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 μg/kg/h to maintain a Ramsay sedation score ≥3 during assisted ventilation and ≥2 after extubation. Patients could be given propofol for additional sedation if necessary; group B patients received propofol-based care according to each investigator's standard practice. Measurements and Main Results: Mean sedation levels were within target ranges in both groups. Mean times to weaning and extubation were similar, although fewer dexmedetomidine patients remained on the ventilator beyond 8 hours. Morphine use was significantly reduced in the dexmedetomidine group. Only 28% of the dexmedetomidine patients required morphine for pain relief while ventilated versus 69% of propofol-based patients (p < 0.001). Propofol patients required 4 times the mean dose of morphine while in the ICU. Mean blood pressure increased initially in both groups, then decreased to 3 mmHg below baseline in dexmedetomidine patients; mean arterial pressure remained at 9 mmHg above baseline in propofol patients. No ventricular tachycardia occurred in the dexmedetomidine-sedated patients compared with 5% of the propofol patients (p = 0.007). Respiratory rates and blood gases were similar. Fewer dexmedetomidine patients received β-blockers (p = 0.014), antiemetics (p = 0.015), nonsteroidal anti-inflammatory drugs (p < 0.001), epinephrine (p = 0.030), or high-dose diuretics (p < 0.001). Conclusion: Dexmedetomidine provided safe and effective sedation for post-CABG surgical patients and significantly reduced the use of analgesics, β-blockers, antiemetics, epinephrine, and diuretics.

AB - Objective: To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). Design: Randomized, open label. Setting: Twenty-five centers in the United States and Canada. Participants: Two hundred ninety-five adults undergoing CABG surgery. Interventions: At sternal closure, patients in group A received 1.0 μg/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 μg/kg/h to maintain a Ramsay sedation score ≥3 during assisted ventilation and ≥2 after extubation. Patients could be given propofol for additional sedation if necessary; group B patients received propofol-based care according to each investigator's standard practice. Measurements and Main Results: Mean sedation levels were within target ranges in both groups. Mean times to weaning and extubation were similar, although fewer dexmedetomidine patients remained on the ventilator beyond 8 hours. Morphine use was significantly reduced in the dexmedetomidine group. Only 28% of the dexmedetomidine patients required morphine for pain relief while ventilated versus 69% of propofol-based patients (p < 0.001). Propofol patients required 4 times the mean dose of morphine while in the ICU. Mean blood pressure increased initially in both groups, then decreased to 3 mmHg below baseline in dexmedetomidine patients; mean arterial pressure remained at 9 mmHg above baseline in propofol patients. No ventricular tachycardia occurred in the dexmedetomidine-sedated patients compared with 5% of the propofol patients (p = 0.007). Respiratory rates and blood gases were similar. Fewer dexmedetomidine patients received β-blockers (p = 0.014), antiemetics (p = 0.015), nonsteroidal anti-inflammatory drugs (p < 0.001), epinephrine (p = 0.030), or high-dose diuretics (p < 0.001). Conclusion: Dexmedetomidine provided safe and effective sedation for post-CABG surgical patients and significantly reduced the use of analgesics, β-blockers, antiemetics, epinephrine, and diuretics.

KW - Alpha-adrenoceptors

KW - Cardiac artery bypass graft

KW - Imidazoles

KW - Sedation

KW - Sympatholysis

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