Anesth Pain Med.  2018 Jan;13(1):65-71. 10.17085/apm.2018.13.1.65.

Beneficial aspect of dexmedetomidine as a postoperative sedative for cardiac surgery

• Kim S
• Kim KM
• Lee S
• Yoo BH
• Kim S
• Park SJ
• Lee J
• Chung E

• KMID: 2436058
• DOI: http://doi.org/10.17085/apm.2018.13.1.65

Abstract

BACKGROUND
The aim of this study was to compare the clinical outcomes of the sedative, analgesic, and hemodynamic effects of dexmedetomidine and midazolam for sedation after coronary artery bypass grafting (CABG).
METHODS
The adult patients undergoing elective CABG surgery under general anesthesia were randomly assigned to the dexmedetomidine (DEX) and midazolam (MDZ) groups. From the time of the sternal closure, dexmedetomidine (0.5-0.7 μg/kg/h) was continuously administered (DEX group), and midazolam (0.03-0.1 mg/kg) was administered by bolus (MDZ group). To maintain the target sedation level (Richmond Agitation-Sedation Scale [RASS] range, −2 to −1) until extubation in the intensive care unit (ICU), continuous doses of dexmedetomidine were regulated and midazolam was administered intermittently. Sedation (RASS) and pain scores (visual analogue scale) and hemodynamic changes were recorded every two hours, until the end of the mechanical ventilation assistance after entering the ICU.
RESULTS
The mean of the fraction within the target sedation level in each patient's total sedation time was 41.0% in the DEX group and 20.7% in the MDZ group (P = 0.026). In the DEX group, the RASS (P < 0.001) and cardiac index were lower (P = 0.047) than those in the MDZ group, but the other hemodynamic parameters and pain scores were not different.
CONCLUSIONS
This study showed that post-operative infusion of dexmedetomidine maintained a stable sedation without side effects in patients who underwent CABG surgery.

Keyword

Conscious sedation; Coronary artery bypass; Dexmedetomidine; Midazolam; Postoperative care

MeSH Terms

Adult
Anesthesia, General
Conscious Sedation
Coronary Artery Bypass
Dexmedetomidine*
Hemodynamics
Humans
Intensive Care Units
Midazolam
Postoperative Care
Respiration, Artificial
Thoracic Surgery*
Dexmedetomidine
Midazolam

Figure

• 

  Fig. 1 CONSORT flow diagram.

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  Fig. 2 Postoperative Richmond Agitation-Sedation Scale (RASS). RASS was significantly lower in the DEX group than that in the MDZ group (P < 0.001). Solid line presents median of dexmedetomidine. Dashed line presents median of midazolam. Error bars are expressed as lowest and highest value, each. DEX: dexmedetomidine, MDZ: midazolam, ICU: intensive care unit.

• 

  Fig. 3 Postoperative hemodynamic factors. Solid line presents mean of dexmedetomidine. Dashed line presents mean of midazolam. Error bars are expressed as standard deviation. (A) Average of systolic blood pressure (SBP), (B) average of mean blood pressure (MBP), (C) average of diastolic blood pressure (DBP), (D) average of pulmonary arterial pressure (PAP), (E) average of heart rate (HR), (F) average of cardiac index (CI). The DEX group had a relatively low CI compared to the MDZ group, and there was no significant difference in other hemodynamic parameters. DEX: dexmedetomidine, MDZ: midazolam, ICU: intensive care unit.

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