Safety and efficacy of ketamine-dexmedetomidine versus ketamine-propofol combinations for sedation in patients after coronary artery bypass graft surgery

Abstract

Background and Aims:Prolonged mechanical ventilation after cardiac surgery is associated with serious complications that increase morbidity and mortality. The present study was designed to compare ketamine-propofol (KP) and ketamine-dexmedetomidine (KD) combinations for sedation and analgesia in patients after coronary artery bypass graft (CABG) surgery as regards hemodynamics, total fentanyl dose, time of weaning from mechanical ventilation, time of extubation, and any adverse outcome.Materials and Methods:Seventy post-CABG patients were sedated using ketamine 1 mg/kg IV then 0.25 mg/kg/h infusion combined with either dexmedetomidine or propofol to maintain Ramsay sedation score ≥4 during assisted ventilation. Group KP received ketamine + propofol 1 mg/kg bolus followed by 25–50 μg/kg/min. Group KD received ketamine + dexmedetomidine 1.0 μg/kg over 20 min and then 0.2–0.7 μg/kg/h. Total dose of fentanyl in the first 24 h, time of weaning, time of extubation, mean arterial blood pressure, heart rate, and Intensive Care Unit (ICU) stay time were recorded.Statistics:Sample size of 35 patients was calculated for 90% power, α = 0.05, β = 0.1, and anticipated effect size = 0.40 using sample size software (G*Power version 3.00.10, Germany). Analytic statistics was performed on IBM compatible computer using SPSS version 11.5 (IBM, New York, United States) software package under Windows XP operating system. All results presented in the form of mean ± standard deviation. Data compared using unpaired Student's t-test, P < 0.05 was considered as statistically significant.Results:Group KD showed a significant decrease in mean time of weaning and extubation in group KD in comparison with group KP (374.05 ± 20.25 min vs. 445.23 ± 21.7 min, respectively, P < 0.001) (432.4 ± 19.4 min and 504 ± 28.7 min, respectively, P < 0.0001). Fentanyl consumption showed a significant decrease in group KD in comparison with group KP (41.94 ± 20.43 μg and 152.8 ± 51.2 μg, respectively, with P < 0.0001). There were insignificant difference between both groups as regards hemodynamic stability and length of ICU stay.Conclusion:Using KD combination for sedation, post-CABG surgery provided short duration of mechanical ventilation with less fentanyl dose requirement in comparison with KP with insignificant difference in both groups as regards hemodynamic stability and length of the ICU stay.

A Comparison of Ketamine-Dexmedetomidine versus Ketamine-Propofolfor Sedation in Children during Upper Gastrointestinal Endoscopy

“…Also, they reported a significant decrease in total fentanyl requirements and shorter duration of mechanical ventilation in KD group [34]. The combination of ketamine-dexmedetomidine provided effective sedation reflected by better endoscopists' and parents' satisfaction than ketamine-propofol, however, the limitation of this study was the high costs required for group KD in comparison to group KP.…”

Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

“…None of the studies assessed all the outcomes at the same time. The study conducted by Liu in 2016 [26] was the only to assess most of the endpoints (all except MVT). hypotension.…”

Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

“…All listed authors have read and approved the manuscript and agree with the submission of "Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis" to BMC Anesthesiology None of the studies assessed all the outcomes at the same time. The study conducted by Liu in 2016 [26] was the only to assess most of the endpoints (all except MVT). The overall quality of the trials is moderate and all of them -except the study by Sheikh -lacked a proper blinding of participants and personnel.…”