Introduction: Prolonged intubation is associated with complications such as ventilator-acquired pneumonia, physical debilitation, and mortality. Studies evaluating propofol and dexmedetomidine use after coronary artery bypass graft (CABG) surgery found decreased time on mechanical ventilation with dexmedetomidine compared to propofol. While available data favors dexmedetomidine, not all studies had the majority of patients meeting the post-op extubation by hour six standard set by the Society of Thoracic Surgeons. The aim of this study was to evaluate the rate of extubation by post-op hour six in patients receiving dexmedetomidine or propofol as the initial sedative agent after cardiac surgery.
Methods: A single-center, retrospective cohort study was conducted evaluating patients who underwent cardiac surgery between April 1, 2023, and April 1, 2025, and received dexmedetomidine or propofol after leaving the operating room. Adult patients who underwent valvular, CABG, aortic operations, or any combination of these procedures were included. The primary outcome was the percentage of patients extubated by post-op hour six. Key secondary outcomes were duration of mechanical ventilation and sedative agent prior to extubation. Safety outcomes included bradycardia, delirium, and new onset post-op atrial fibrillation.
Results: Of the 83 patients included, 55 received propofol and 28 dexmedetomidine as their primary sedative agent. Forty-four patients (80%) in the propofol group and 21 (75%) in the dexmedetomidine group achieved extubation by post-op hour six (p=0.60). The average duration of mechanical ventilation was higher in the propofol group (7.32 vs 4.95 hours, p=0.91). The duration of propofol use prior to extubation was slightly higher, but not statistically significant (4.38 vs 3.43 hours, p=0.69). There was no significant difference in the rate of adverse events between the groups; however, two patients in the propofol group were noted to have bradycardia leading to medication discontinuation versus zero in the dexmedetomidine group (p=0.31).
Conclusions: The results of this study suggest no difference in achieving extubation by post-op hour six for patients who receive dexmedetomidine or propofol as their primary sedative agent following cardiac surgery.
