[Comparison of dexmedetomidine and propofol for short-term sedation in early postoperative period after cardiac surgery].

PURPOSE OF THE STUDY: To compare the efficacy of Dexmedetomidine and Propofol for short-term controlled sedation and analgesia in the early postoperative period after cardiac surgery.

METHODS: We performed open randomized prospective comparative study in 55 cardiovascular surgery patients. In the early postoperative period 28 patients received infusion of Dexmedetomidine (0.2-0.7 microg/kg per hour) while 27 patients--Propofol (0.3-2(system text of symbol)). Analgesia was carried out with Ketoprofen 100 mg/12h and additional 20 mg of Trimeperidine in case of pain intensity > or = 3 points (5-level verbal pain score). Sedation and agitation level (RASS scale), speed of awakening (Aldrete score), duration of mechanical ventilation and stay in the ICU, need for additional opioid injections, type and frequency of side effects were evaluated.

RESULTS: We didn't find any significant differences in the duration of mechanical ventilation or rate of awakening after the end of infusion between the groups. Dexmedetomidine in the majority of cases resulted in mild or moderate sedation, Propofol--in deeper level of sedation. Retrograde amnesia was reached significantly more often (p < 0.05) in Dexmetomedine group. The daily dose of Trimeperidine in Propofol group was significantly higher (8 mg and 18 mg on average, p = 0.02). Differences in side effects between the groups were noted--bradycardia (Dexmetomedine--10 (39%), Propofol--3 (11%), p = 0.004) arterial hypotension (Dexmetomedine--9 (32%), Propofol--15 (59%), p = 0.002) and general malaise (Dexmetomedine--2 (7%), Propofol--6 (24%), p = 0.001). The length of stay in the ICU in Dexmetomedine group was significantly lower (1,1 days vs 2,6 days respectively, p = 0.006).

CONCLUSIONS: To compare with Propofol Dexmetomedine induces less sedation level and more often provides retrograde amnesia with the same duration of mechanical ventilation and awakening rate. Dexmetomedine provides its own analgesic effect and shortens the length of patient's stay in ICU. Bradycardia was noted more frequently in Dexmedetomidine while arterial hypotension, general malaise and delirium--in Propofol group.