Hemodynamic effects of dexmedetomidine versus propofol in cardiac surgery: a systematic review and meta-analysis

Cardiac surgery, particularly open-heart procedures such as coronary artery bypass grafting and valve surgery, is one of the most common curative options for ischemic heart disease, congenital heart defects, and valvular disease but is also associated with severe hemodynamic hazards. Intravenous anesthetic agents such as propofol and dexmedetomidine are employed to sedate such patients in routine clinical practice. There is, however, conflicting and sporadic evidence in the literature regarding the relative effects of these two agents on hemodynamic parameters. This review systematically analyzed and contrasted the hemodynamic effects of dexmedetomidine and propofol in patients undergoing cardiac surgery. Systematic searches in the PubMed, Scopus, Embase, Web of Science, CINAHL, Cochrane Library, and Google Scholar databases were performed for randomized controlled trials published between December 2000 and 18 January 2025. Studies in which adult patients underwent cardiac surgery (e.g., coronary artery bypass grafting or valve surgery) and received dexmedetomidine or propofol for intraoperative or immediate postoperative intensive care unit (ICU) sedation were included. This was a PRISMA-guided review, and the extracted data were meta-analyzed and descriptively analyzed. The primary outcomes were hypotension and bradycardia. Secondary outcomes included vasopressor requirements, tachycardia, heart rate, atrial fibrillation (AF), ventricular tachycardia, and bleeding. Odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were pooled via random-effects models. Sensitivity analysis and assessment of publication bias were performed as needed. Compared with propofol, dexmedetomidine significantly increased the risk for hypotension (OR = 1.76; 95% CI: 1.25–2.48; p < 0.001) and bradycardia (OR = 2.89; 95% CI: 1.28–6.49; p = 0.01). Alternatively, dexmedetomidine significantly reduced vasopressor requirements (OR = 0.52; 95% CI: 0.32–0.84; p = 0.007) and lowered the heart rate (MD = − 4.78 beats/min; 95% CI: − 7.47 to − 2.26; p < 0.001). No considerable differences were observed in tachycardia, ventricular tachycardia, AF, or bleeding. Sensitivity analysis was employed to check for the stability of the findings, and no publication bias was detected. This meta-analysis revealed that, compared with propofol, dexmedetomidine is associated with a greater incidence of hypotension and bradycardia but lower vasopressor requirements. No considerable differences were observed in ventricular tachycardia, AF, bleeding or any other hemodynamic parameters. Evidence for several secondary outcomes remains limited; therefore, findings for less frequently reported endpoints should be interpreted cautiously. Not applicable.