期刊
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
卷 17, 期 5, 页码 576-584出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/S1053-0770(03)00200-3
关键词
alpha(2)-adrenoceptors; imidazoles; sedation; sympatholysis; cardiac artery bypass graft
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 mug/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 mug/kg/h to maintain a Ramsay sedation score greater than or equal to3 during assisted ventilation and greater than or equal to2 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 beta-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, beta-blockers, antiemetics, epinephrine, and diuretics. (C) 2003 Elsevier Inc. All rights reserved.
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