Effect of a Dexmedetomidine Substitution During a Nationwide Propofol Shortage in Patients Undergoing Coronary Artery Bypass Graft Surgery

Reichert, Marc G.; Jones, Warren T.; Royster, Roger L.; Slaughter, Thomas; Kon, Neal D.; Kincaid, Edward H.

doi:10.1592/phco.31.7.673

Cited by 20 publications

(26 citation statements)

References 10 publications

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“…Our results found dexmedetomidine treatment did not appear to reduce the length of ICU stay (MD -3.44, 95% CI -11.40, 4.52, P = 0.40) [15,16,18,20], length of hospital stay (MD -0.28, 95% CI -0.64, 0.07, P = 0.36) [15-17,20,21], or morphine equivalents (MD 0.45, 95% CI -1.86, 2.77, P = 0.70) [13,15,16,18] compared with other sedatives (Additional File 1). There was significant heterogeneity between the pooled studies in the length of mechanical ventilation, length of ICU stay and morphine equivalents.…”

Section: Resultsmentioning

confidence: 99%

“…For example, given that virtually all patients were intubated for surgery, not all studies reported the mean value and standard deviation of the length of mechanical ventilation. We contacted authors [11-13] for additional detail on the outcomes mentioned above; however, no additional information was added. A ratio of relative risks and difference between treatment agents for categorical and continuous outcomes respectively, were extracted from all publications (if presented).…”

Section: Methodsmentioning

confidence: 99%

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Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Lin

Chen

et al. 2012

Crit Care

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IntroductionThe aim of this study was to explore the use of dexmedetomidine as a safe and efficacious sedative agent in post-cardiac surgery patients.MethodsA systematic literature search of MEDLINE, EMBASE, the Cochrane Library and Science Citation Index until January 2012 and review of studies was conducted. Eligible studies were of randomized controlled trials or cohort studies, comparing dexmedetomidine with a placebo or an alternative sedative agent in elective cardiac surgery, using dexmedetomidine for postoperative sedation and available in full text. Two reviewers independently performed study selection, quality assessment, and data extraction.ResultsThe search identified 530 potentially relevant publications; 11 met selection criteria in this meta-analysis. Our results revealed that dexmedetomidine was associated with a shorter length of mechanical ventilation (mean difference -2.70 [-5.05, -0.35]), a lower risk of delirium (risk ratio 0.36 [0.21, 0.64]), ventricular tachycardia (risk ratio 0.27 [0.08, 0.97]) and hyperglycemia (risk ratio 0.78 [0.61, 0.99]), but may increase the risk of bradycardia (risk ratio 2.08 [1.16, 3.74]). But there was no significant difference in ICU stay, hospital stay, and morphine equivalents between the included studies. Dexmedetomidine may not increase the risk of hypotension, atrial fibrillation, postoperative nausea and vomiting, reintubation within 5 days, cardiovascular complications, postoperative infection or hospital mortality.ConclusionsDexmedetomidine was associated with shorter length of mechanical ventilation and lower risk of delirium following cardiac surgery. Although the risk of bradycardia was significantly higher compared with traditional sedatives, it may not increase length of hospital stay and hospital mortality. Moreover, dexmedetomidine may decrease the risk of ventricular tachycardia and hyperglycemia. Thus, dexmedetomidine could be a safe and efficacious sedative agent in cardiac surgical patients.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Lin

Chen

et al. 2012

Crit Care

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“…18 Opioid requirements at 12 and 24 hours postsurgery, measured as morphine equivalents, were similar between patients who received propofol and dexmedetomidine (10.7 + 9.1 mg propofol vs 7.6 + 5.8 mg dexmedetomidine at 12 hours, P ¼ .10; and 19.8 + 13.0 mg vs 17.3 + 8.2 mg, respectively, at 24 hours, P ¼ .37). Time to extubation was also similar between both the groups, 300 minutes in the propofol group and 318 minutes in the dexmedetomidine group, after arrival to the ICU (P ¼ .5).…”

Section: Clinical Implications Of Drug Shortages On Sedationmentioning

confidence: 86%

Clinical Dilemmas and a Review of Strategies to Manage Drug Shortages

Rider

Templet

Daley

et al. 2013

Journal of Pharmacy Practice

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“…This circumvents many of the adverse effects of the latter drugs, chiefly respiratory depression and is one of the most important reasons for earlier extubation and discharge of dexmedetomidine sedated ICU patients. 12 Hoy and Keating, in their study also used dexmedetomidine for ICU patients and observed that IV dexmedetomidine is generally well tolerated when used in mechanically ventilated ICU patients. 13 Eren and Cukurova, concluded that dexmedetomidine was as effective as high doses of benzodiazepines as far as ICU sedation was concerned with minimal haemodynamic and respiratory effects.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine versus propofol as a sedative agent in the intensive care unit: a randomized single blinded prospective study

2018

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Background: Sedation is an essential prerequisite for every ICU patient. It promotes patient comfort, helps in alleviation of anxiety, stabilizes vitals and reduces the time to extubation and ICU discharge. This study aims at comparing dexmedetomidine versus propofol in ICU sedation with respect to maintenance of vitals, time to extubation, incidence of adverse effects and cost effectiveness.Methods: 60 intubated and mechanically ventilated post-surgical ICU patients were randomly allocated to two groups of 30 each. Group D received dexmedetomidine infusion as a loading dose of 0.1mcg/kg/min IV over 10 minutes followed by maintenance infusion of 0.2-0.7mcg/kg/h IV. Group P received propofol infusion as a loading dose of 5mcg/kg/min IV over 5 minutes followed by a maintenance infusion of 0.3-3mg/kg/h IV. Patients in both groups were maintained at Richmond agitation sedation score of -1 to -2. Measurements of HR, NIBP, SpO2 were taken at regular intervals till cessation of sedation and extubation. Data thus collected was subjected to statistical analysis.Results: Dexmedetomidine was seen to be comparable to propofol as far as maintaining vitals was concerned. Group D (dexmedetomidine) had a statistically significant shorter mean duration to sedation cessation and extubation than group P (propofol). Dexmedetomidine also had the added advantages of minimal respiratory depression, decreased opioid requirements as well as greater cost effectiveness.Conclusions: Dexmedetomidine was found to be a better choice for sedation in the ICU compared to propofol.

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Effect of a Dexmedetomidine Substitution During a Nationwide Propofol Shortage in Patients Undergoing Coronary Artery Bypass Graft Surgery

Cited by 20 publications

References 10 publications

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Clinical Dilemmas and a Review of Strategies to Manage Drug Shortages

Dexmedetomidine versus propofol as a sedative agent in the intensive care unit: a randomized single blinded prospective study

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