Key result
Dexmedetomidine sedation reduces postoperative AF by ~72% vs propofol in cardiac surgery.
Why the study?
Does dexmedetomidine sedation reduce the incidence of postoperative atrial fibrillation in cardiac surgery patients compared to propofol?
RCT (n=88)
Open-label
Does dexmedetomidine sedation reduce the incidence of postoperative atrial fibrillation in cardiac surgery patients compared to propofol?
Effect estimate: OR 0.28 (95% CI 0.10-0.80)
Absolute Event Rate: 13.6% vs 36.4%
p-value: p=0.025
In patients recovering from cardiac surgery, open-label dexmedetomidine sedation significantly reduced the incidence of new-onset postoperative atrial fibrillation and shortened ICU stay compared to propofol, though it was associated with a higher rate of hypotension.
Favors dexmedetomidine over propofol to reduce postoperative atrial fibrillation after cardiac surgery despite more hypotension; confirms benefit in this RCT.
BACKGROUND: Atrial fibrillation occurs frequently in patients following cardiac surgery and can be a cause of increased morbidity and mortality. The use of dexmedetomidine to prevent atrial fibrillation is unclear. The present study was designed to evaluate the effect of dexmedetomidine sedation on the incidence of atrial fibrillation after cardiac surgery. METHODS: Upon arrival to the intensive care unit (ICU), cardiac surgery patients without prior atrial fibrillation or flutter were randomized to receive either dexmedetomidine (0.2-1.5 μg/kg/h) or propofol (0.3-3 mg/kg/h) open-label titrated to a target Richmond agitation-sedation scale of 0 to -3. Our primary endpoint was the incidence of postoperative atrial fibrillation, and the secondary end points were the length of ICU stay, length of hospital stay, and hospital costs. RESULTS: Atrial fibrillation occurred in 6 of 44 patients (13.6 %) in the dexmedetomidine group compared to 16 of 44 patients (36.4 %) in the propofol group (odds ratio = 0.28; 95 % confidence interval, 0.10, 0.80; P = 0.025). The median (interquartile range) length of ICU stay in the dexmedetomidine group was significantly lower than in the propofol group (2.9 (2.4-3.5) vs 3.5 (2.7-4.5 days, P = 0.008), with a trend toward a decrease in median hospital costs (86,367 vs 77,874 Chinese yuan; P = 0.068). The incidence of hypotension was higher in the dexmedetomidine group than in the propofol group (25/44 (56.8 %) vs 13/44 (29.5 %); P = 0.017). CONCLUSIONS: Dexmedetomidine sedation reduced the incidence of new-onset postoperative atrial fibrillation and shortened the length of ICU stay in patients after cardiac surgery compared to propofol sedation. Dexmedetomidine treatment was associated with more episodes of hypotension. TRIAL REGISTRATION: chictr.org.cn: ChiCTR-IPR-16008231 , retrospectively registered: April 6, 2016. This trial was not prospectively registered due to a lack of importance applied to trial registration.
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Liu et al. (2016) conducted an RCT in Postoperative atrial fibrillation after cardiac surgery (n=88). Dexmedetomidine vs. Propofol (0.3-3 mg/kg/h) was evaluated on Incidence of postoperative atrial fibrillation (OR 0.28, 95% CI 0.10-0.80, p=0.025). Dexmedetomidine sedation reduced postoperative atrial fibrillation compared to propofol in cardiac surgery patients (13.6% vs 36.4%; OR 0.28; 95% CI 0.10-0.80; P=0.025).
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