Dexmedetomidine Versus Propofol for Early Postoperative Sedation After Adult Cardiac Surgery: A Narrative Review of Hemodynamic Safety and Recovery Outcomes

Early postoperative sedation after adult cardiac surgery requires balancing comfort and ventilator tolerance against evolving circulatory function and readiness for extubation.This narrative review compares dexmedetomidine and propofol during postoperative mechanical ventilation and progression toward extubation, emphasizing hemodynamic safety and recovery outcomes.The targeted literature search separated direct postoperative comparisons from perioperative adjunct trials and general intensive care evidence.Direct randomized comparisons yielded mixed findings for delirium, arrhythmia, and hemodynamic outcomes.Pooled findings showed differing patterns for hypotension, bradycardia, and vasopressor use, with interpretation dependent on the definitions used.Recovery findings were inconsistent; some randomized and pooled analyses favored shorter ventilation with dexmedetomidine, while a historical cohort associated it with longer adjusted time to extubation.Pooled delirium benefits were also sensitive to publication bias adjustment.Differences in treatment timing, sedation targets, analgesic co-interventions, and outcome definitions limit comparison across studies.Neither agent shows universal superiority for hemodynamic safety or recovery outcomes.Selection should reflect the sedation goal, administered regimen, and observed circulatory response.Future comparisons should standardize sedation and rescue protocols and distinguish transient adverse events from treatment-limiting compromise.