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Dexmedetomidine Versus Propofol Sedation Improves Sublingual Microcirculation After Cardiac Surgery: A Randomized Controlled Trial.

Abstract：

OBJECTIVES:To compare the effects of dexmedetomidine and propofol on sublingual microcirculation in patients after cardiac surgery. DESIGN:A prospective, randomized, single-blind study. SETTING:University hospital. PARTICIPANTS:Adult patients undergoing elective valve surgery with cardiopulmonary bypass. INTERVENTIONS:On arrival in the intensive care unit (ICU), patients were assigned randomly to receive either dexmedetomidine (0.2-1.5 μg/kg/h) or propofol (5-50 μg/kg/min) with open-label titration to a target Richmond Agitation-Sedation Scale of 0 to -3. MEASUREMENTS AND MAIN RESULTS:Sublingual microcirculation was recorded using sidestream dark-field imaging at ICU admission (baseline [T1]) and 4 hours (T2) and 24 hours after ICU admission (T3). At T2, median changes in perfused small-vessel density and the De Backer score from baseline were significantly greater in the dexmedetomidine group (n = 29) than in the propofol group (n = 32) (1.3 v 0 mm/mm2, p = 0.025; 0.9 v -0.1/mm, p = 0.005, respectively); median changes in small-vessel density and the proportion of perfused small vessels from baseline also tended to be higher in the dexmedetomidine group compared with the propofol group (1.0 v -0.1 mm/mm2, p = 0.050; 2.1% v 0.5%, p = 0.062, respectively). At T3, there still was a trend toward greater improvements in the small-vessel density, proportion of perfused small-vessels, perfused small-vessel density, and De Backer score from baseline in the dexmedetomidine group than in the propofol group. CONCLUSIONS:This trial demonstrated that dexmedetomidine sedation may be better able to improve microcirculation in cardiac surgery patients during the early postoperative period compared with propofol.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

Liu X,Zhang K,Wang W,Xie G,Cheng B,Wang Y,Hu Y,Fang X

doi

10.1053/j.jvca.2016.05.038

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

1509-1515

issue

eissn

1053-0770

issn

1532-8422

pii

S1053-0770(16)30160-4

journal_volume

pub_type

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Dexmedetomidine Versus Propofol Sedation Improves Sublingual Microcirculation After Cardiac Surgery: A Randomized Controlled Trial.