Comparison Between Dexmedetomidine and Propofol on Outcomes After Coronary Artery Bypass Graft Surgery

A Retrospective Study

Jie Hu; Bingfeng Lv; Raha West; Xingpeng Chen; Yali Yan; Chen Pac Soo; Daqing Ma

Disclosures

BMC Anesthesiol. 2022;22(51) 

In This Article

Results

Baseline Patient Demographic and Perioperative Characteristics

Routinely collected data were captured by the direct care team for patients undergoing CABG at Luoyang Central Hospital from 1st of January 2012 to 31st of December 2019. A total of 1503 patients had CABG during the studied period being carried out by the same team of surgeons and anesthesiologists; 115 of them were excluded based on our exclusion criteria. Data for the study were from the remaining 1388 patients (Figure 1). Of those, 831 patients received DEX, and 557 received propofol as an anaesthetic adjunct during surgery and postoperative sedation. There were no significant differences between the two groups in terms of age, gender, body mass index, blood type, ASA classification and comorbidities, including stroke, chronic obstructive pulmonary disease, diabetes, hyperlipidaemia, smoking, liver dysfunction, chronic kidney disease and chronic heart failure (Table 1). There were more patients with cardiac arrhythmia comorbidity (6.64% vs 3.37%, P = 0.005) and alcoholism (29.44% vs 19.98%, P < 0.001) in the propofol compared to the DEX group. Before surgery, there were no differences in kidney function, white blood cells, and neutrophils between the two groups. However, all measurements were significantly raised after surgery in the propofol group compared to DEX (Table 2).

Figure 1.

Flow chart of patients included for data analysis

Primary Outcomes

Perioperative DEX significantly reduced pulmonary complications collectively, including hypoxemia, atelectasis, pneumonia, bronchospasm, and pleural effusion, with 7.82% total complications in the DEX compared to 13.29% in the propofol group (P < 0.01). When broken down into the individual pulmonary complication, although the general trend, except for pleural effusion, pointed towards a better pulmonary outcome for the DEX group, only atelectasis was statistically different with 1.32% incidence in the DEX compared to 2.87% in propofol (P = 0.048) (Table 3).

Looking at important perioperative factors that could influence postoperative pulmonary complications, DEX (OR 0.544, P = 0.002) and CPB (0.140, P < 0.001) were associated with a decrease in postoperative lung complications but diabetes (OR 1.500, P = 0.040) and wound infection (OR 3.995, P < 0.001) increased the risk of lung complications (Table 4). Preoperative cardiac arrhythmia and alcoholism, which were significantly more common in the propofol group than DEX, did not significantly worsen postoperative pulmonary complications following multivariate logistic regression analysis, OR 0.709, P = 0.548 and OR 0.975, P = 0.913 respectively.

Secondary Outcomes

For the secondary outcomes, perioperative DEX infusion was associated with a significant reduction in mechanical lung ventilation duration, LOS in ICU after surgery and LOS in hospital. The mean time to extubation was 18 (13,25) hours in the DEX vs 21 (16,37) hours in the propofol group (P < 0.001). LOS in ICU following surgery was 51 (42,90) hours with DEX compared to 59 (46,94.5) hours in the propofol group (P = 0.001). The length of hospital stay was also shorter with DEX compared to the propofol group with 20 (17,24) vs 22 (17,28) days, respectively (P < 0.001) (Table 3).

The incidence of postoperative wound dehiscence or infection was also significantly lower in the DEX group than propofol; 2.53% vs 6.64%, respectively (P < 0.001). There were no significant differences in the 30 days mortality, postoperative complications such as arrhythmias, acute kidney injury, stroke or upper gastrointestinal bleeding (Table 3). Cardiac ejection fraction and C-reactive protein showed no statistical significance between the two groups before and after surgery (Figure 2).

Figure 2.

Cardiac ejection fraction (EF) (A) and C-reactive protein (CRP) (B) data before and after surgery under propofol (n = 557) or dexmedetomidine anesthesia (n = 831). Data are median (IQR). There was no statistical significance between before and after surgery

Exploratory Outcomes

Patients receiving DEX had a slightly shorter surgical time than propofol. Patients in the DEX group required fewer opioids (sufentanil) and inotropic drugs than those in the propofol group (P = 0.001). There was no significant difference in the two groups concerning the intraoperative fluid administration, urine output, autologous blood transfusion, extracorporeal circulation, and the use of an intra-aortic balloon pump (Table 5).

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