Comparison Between Dexmedetomidine and Propofol for Sedation on Outcomes After Cardiac Surgery in Patients Requiring Mechanical Ventilation: A Meta-Analysis of Randomized-Control Trials

Lubna Sattar; Ibrahim Reyaz; Anurag Rawat; Raam Mannam; Abhimanyu Karumanchi; Venu Gopal Reddy Depa; Saima Batool; Muhammad Usama

doi:10.7759/cureus.42212

Comparison Between Dexmedetomidine and Propofol for Sedation on Outcomes After Cardiac Surgery in Patients Requiring Mechanical Ventilation: A Meta-Analysis of Randomized-Control Trials

Cureus. 2023 Jul 20;15(7):e42212. doi: 10.7759/cureus.42212. eCollection 2023 Jul.

Authors

Lubna Sattar¹, Ibrahim Reyaz², Anurag Rawat³, Raam Mannam⁴, Abhimanyu Karumanchi⁵, Venu Gopal Reddy Depa⁶, Saima Batool⁷, Muhammad Usama⁸

Affiliations

¹ Medicine, Shadan Institute of Medical Sciences, Hyderabad, IND.
² Internal Medicine, Christian Medical College and Hospital, Ludhiana, IND.
³ Interventional Cardiology, Himalayan Institute of Medical Sciences, Dehradun, IND.
⁴ General Surgery, Narayana Medical College, Nellore, IND.
⁵ Medicine, Kamineni Institute of Medical Sciences, Hyderabad, IND.
⁶ Internal Medicine, MNR Medical College and Hospital, Sangareddy, IND.
⁷ Internal Medicine, Hameed Latif Hospital, Lahore, PAK.
⁸ Neurology, Sheikh Zayed Medical College & Hospital, Rahim Yar Khan, PAK.

Abstract

The aim of this study was to compare outcomes between dexmedetomidine and propofol for sedation after cardiac surgery in patients requiring mechanical ventilation. This meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Online databases, including EMBASE, PubMed, and the Cochrane Library, were comprehensively searched to identify relevant randomized controlled trials (RCTs) comparing the safety and efficacy of dexmedetomidine and propofol in patients undergoing cardiac surgery and requiring mechanical ventilation. The examined outcomes included the mean length of intensive care unit (ICU) stay in hours, duration of mechanical ventilation in hours, length of hospital stay in days, and number of patients diagnosed with delirium. A total of 14 studies were included in the present meta-analysis while 1360 patients undergoing cardiac surgery were involved in these studies. Pooled results showed that the duration of mechanical ventilation was lower in the dexmedetomidine group compared to the propofol group (mean difference (MD): 0.75, 95% confidence interval (CI): 0.06-1.44, p-value: 0.03). We also found a significantly low length of stay in ICU in the dexmedetomidine group compared to the propofol (MD: 0.89, 95% CI: 0.04-1.74, p-value: 0.04). The length of hospital stay was also significantly lower in patients receiving dexmedetomidine as compared to the propofol group (MD: 0.51, 95% CI: 0.32-0.70, p-value<0.001). Risk of delirium was significantly higher in patients receiving propofol compared to patients receiving dexmedetomidine (RR: 2.02, 95% CI: 1.48-2.74, p-value<0.001). In conclusion, our meta-analysis provides evidence of the beneficial impacts of dexmedetomidine on clinical outcomes in patients undergoing cardiac surgery. Dexmedetomidine was associated with a significant reduction in the duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and hospital, and the risk of delirium.

Keywords: cardiac surgery; dexmedetomidine; meta-analysis; post-operative outcomes; propofol.

Publication types

Review