Dexmedetomidine versus Propofol for Cardiopulmonary Bypass
Introduction: Propofol has been used as part of balanced anesthetic in cardiovascular surgery patients. Dexmedetomidine is newer agent with multiple benefits and may be superior than propofol.
Literature review: Both dexmedetomidine and propofol do not significantly decrease cerebral tissue oxygenation and deemed to be neuroprotective. Both agents had same pressor requirement, but lower percentage of hemodynamic fluctuation seen with dexmedetomidine. Shorter length of stay and length of mechanical ventilation in dexmedetomidine group. Both agents were not shown to reduce atrial fibrillation, but dexmedetomidine was shown to reduce ventricular tachycardia while propofol did not. Systemic review of 56 studies showed that dexmedetomidine may be superior agent in reducing post op delirium among other agents such as propofol, opioids, midazolam, and ketamine. Intraoperative opioid and anesthetic requirement were lower in dexmedetomidine group.
Description of case: 68-year-old male with history of CAD, GERD, T2DM, OSA, and angina undergoing CABGX3. Cath report showed 3 vessel disease with normal EF and other preop vital signs were normal. Patient underwent induction without any issues and was started on dexmedetomidine drip at 0.3mcg/kg/min. This infusion was titrated during the procedure ranging from 0.1-0.7mcg/kg/min. Case totals for the case were crystalloids 2L, UOP 1100mL, EBL 100ml, and 5 hours total of anesthesia time. After procedure ended, patient was transferred to ICU while ETT in placed with dexmedetomidine drip at 0.3mcg/kg/min and norepinephrine drip at 0.03mcg/kg/min. Patient was able to wake up, follow commands and successfully extubated 2 hours post op. Patient was discharged on POD 5 without complications.
Discussion and conclusion: The patient in this case report received dexmedetomidine infusion throughout the procedure as well as postoperatively. Patient maintained his cerebral oximetry > 50, did not suffer from arrythmia, his hemodynamic was stable, his ICU course was short, and patient was also extubated in 2 hours after arrival to the unit. In addition, patient did not suffer from post-operative delirium. Overall, the patient’s outcomes mirrored the literature review of dexmedetomidine. In conclusion, dexmedetomidine infusion during cardiac surgery may be superior to propofol infusion due to better prevention of ventricular arrythmia, hemodynamic stability, reducing length of mechanical ventilation and ICU stay, and prevention of postoperative delirium.
Cardiopulmonary bypass, dexmedetomidine, propofol, arrhythmia, post-operative delirium, Cerebral regional tissue oxygen saturation, length of ICU stay, and length of mechanical ventilation
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