Introduction: Patient sedation in the intensive care unit after cardiac surgeries with cardiac pulmonary bypass (CPB) has an element of negative impact on the hemodynamic status of the patient. Vasoplegia caused by the use of of artificial blood circulation in combination with the use of hypnotics can lead to a large number of complications and increase the duration of the patient’s stay in the conditions of the intensive care unit. Purpose: to compare the effect on the hemodynamic status of patients after cardiac surgery with the use of artificial blood circulation 3 drugs for sedation: propofol, dexmedetomidine and their combination. Materials and methods: A randomized controlled parallel study was conducted. The study included 356 patients over 18 years of age who underwent cardiac surgical treatment with CBP. Statistical data processing was carried out on the basis of Prism 9.0 software. Results and discussion: The frequency of hemodynamic disturbances that required vasopressors in the early postoperative period was 35.79% (n= 34) in the propofol group (n= 95) ,12.35% (n = 10) in the group of the combination of propofol and dexmedetomidine (n= 81), 31.25% (n=5) dexmedetomidine sedation group (n= 16). (p=0.0011) Conclusions: Vasopressors infusion has been less common in the propofol and dexmedetomidine combination group (p = 0.0011).

Introduction: Most patients who are indicated for cardiac surgery are patients with reduced left ventricular ejection fraction (LVEF). Also, most patients after cardiac surgery receive sedation, which, in combination with reduced LVEF, can lead to severe hemodynamic disturbances. Whether there is a relationship between the drug for sedation in the early postoperative period in patients after cardiac surgery and the initial left ventricular ejection fraction until the end, there is still no consensus. Purpose: To monitor the relationship between the drug for sedation, the patients' initial left ventricular ejection fraction and the frequency of the need for sympathomimetic support and inotropic support in the early postoperative period. Materials and methods: A randomized controlled parallel study was conducted. The study included 194 patients over 18 years of age who underwent cardiac surgical treatment using artificial blood circulation. The control point for evaluating the effect of sedation on hemodynamics was the use of inotropic and sympathomimetic therapy and the analysis of the frequency of use in groups with different ejection fractions of the left ventricle. An assessment of the frequency of vasopressor/inotropic therapy without taking into account the sedation strategy was also carried out. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software. Results: In the group receiving propofol sedation (n=95), 83.16 % (n=79) of patients received inotropic/vasopressor therapy, which is 40.72 % of the total number of patients in all 3 groups (n=194). In the group receiving received sedation with dexmedetomidine (n=16), 81.25 % (n=13) received supportive inotropic/vasopressor therapy, which is 6.7 % of the total number of patients in all 3 groups (n=194). Patients who were sedated with a combination of these drugs (n =83) received supportive inotropic/vasopressor therapy in 91.57 % (n=76) of cases, which is 39.18 % of the total number of patients in all 3 groups (n=194). (p = 0.2093). When analyzing the frequency of use of inotropic therapy in each LVEF group, regardless of the type of sedation, it was found that the frequency of use depended on the fraction of LVEF emission below 55 % (p=0.0484). When comparing the groups of patients with LVEF ≥ 55 % and LVEF 40 – 30 %, more patients with PV 40 – 30 % received inotropic support (p=0.0299 RR 0.7878 95 % CI 0.6542-0.9528). No difference was found in the frequency of use of inotropic support when comparing LVEF ≥ 55 % and LVEF≤ 30% (p=0.7474 RR 0.9103 95% CI 0.7255-1.275), PV 55 – 40% and PV 40 – 30 % (p=0.4527 RR – 1.592) Conclusions: According to the conducted study, in patients in the early postoperative period after cardiac surgery, no influence was found between the strategy of sedation, the output fraction of the left ventricle and the frequency of use of norepinephrine, dobutamine, dopamine or their combination (p=0.2093). But it was found that inotropic/vasopressor therapy was more often needed in patients with LVEF less than 55 % regardless of the sedation strategy. The doses of dobutamine and dopamine were the same in all 3 sedation groups, which can speak in favor of the absence of a difference in the frequency of the syndrome of decreased cardiac output. During the analysis, it was also found that the doses and frequency of norepinephrine use were higher in the group where sedation was carried out with propofol (p=0.0011), which may indicate that sedation with propofol leads to a higher frequency of hypotension, the correction of which requires higher doses of norepinephrine.

Over the past decades, many approaches have been changed in intensive care and in anesthesiology. Most of these changes were included in the guidelines now well known as fast-track protocols (protocols for enhanced recovery after surgery). Cardiac anesthesiology was not an exception. Preoperative, intraoperative and postoperative management of the patient are the main components of these protocols, which are aimed at reducing the length of stay (LOS) of patients in the hospital and intensive care units (ICU). The aim. To detect the relationship between the sedation strategy and the duration of the hospital LOS and the ICU LOS. Materials and methods. This was a randomized, controlled, parallel study. We analyzed 194 patients over 18 years of age who underwent cardiac surgical treatment using artificial blood circulation. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software. Results. According to our research, the average hospital LOS was 7.779 ± 2.844 days in the propofol group (n = 95), 7.188 ± 1.601 days in the dexmedetomidine group (n = 16). In the group where patients were sedated with a combination of drugs (n = 83), the average length of hospitalization was 5.904 ± 1.535 days. The average ICU LOS was 2.463 ± 1.090 days in the propofol group and 2.375 ± 1.360 days in the dexmedetomidine group. In the group where patients were sedated with a combination of drugs (n = 83), the average ICU LOS was 2.361 ± 0.8776 days. The hospital LOS of patients who were sedated with a combination of drugs was lower (p < 0.0001). When comparing the ICU LOS, no difference was found in all three sedation groups (p = 0.3903). According to the analysis conducted in the propofol group, the ICU LOS was shorter in patients who did not receive vasoactive therapy (p = 0.0299). In the dexmedetomidine sedation group, no difference was found between the ICU LOS in patients with or without vasoactive support (p = 0.5289). In the group of patients who underwent sedation with a combination of drugs, the ICU LOS was shorter in the group of patients who underwent correction with vasoactive drugs (p < 0.0001). Conclusion. Sedation with a drug combination (dexmedetomidine and propofol) may reduce hospital LOS (p < 0.0001). There was no influence of any sedation strategy on the ICU LOS (p = 0.3903). Early initiation of vasoactive support with sedative drug combination (dexmedetomidine and propofol) shortens the ICU LOS (p < 0.0001).