COMPARISON OF PERIOPERATIVE SEDATION WITH DEXMEDETOMIDINE AND PROPOFOL IN PATIENTS ON MECHANICAL VENTILATION WITH THORACIC AND ABDOMINAL SURGERY
| Autor: | M.V. MELNYCHENKO, D.V DMITRIEV, O.A. NAZARCHUK |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | PAIN, ANAESTHESIA & INTENSIVE CARE. :19-26 |
| ISSN: | 2520-226X 2519-2078 |
| Popis: | Background: Sedatives used during thoracic and abdominal surgery may affect hemodynamics, patient extubation time, length of stay in the intensive care unit, and the incidence of delirium. Aim: Perioperative assessment of the level sedation with propofol and dexmedetomidine, their effect on hemodynamics with determination of non-invasive cardiac output (esCCO), extubation time, duration of stay in ICU department and frequency of postoperative delirium. Methods: The study included 121 patients over 18 years of age who underwent thoracic and abdominal surgery and received dexmedetomidine or propofol infusion for sedation in the perioperative period. The main result of the study was the determination of extubation time and indicators of non-invasive monitoring of hemodynamics with measurement of cardiac output (esCCO) using the Nihon Kohden monitor. Secondary results of the study were the length of stay in the intensive care unit and hospital, the frequency of delirium. Results. Dexmedetomidine usage (n=52) as an intraoperative and postoperative sedative as opposed to propofol (n=69) was associated with a higher probability of extubation (HR=1.65, 95% CI =1.23–2.21, P=0.001). The longer duration of the operation was associated with a decrease in the probability of extubation (HR=0.83, 95% CI=0.62-0.94, P=0.029), and elderly patients were less likely to rapid extubation (HR=0.73; 95% CI=0.62-0.94, P=0.005). Baseline noninvasive cardiac output parameters of propofol and dexmedetomidine patients were 5.9±1.1 l/min and 6.1±0.6 l/min, respectively. At the end of the operation, the CO values were lower than baseline in patients in the propofol and dexmedetomidine groups by 11.9 % and 6.6 %, respectively. There was no significant association between dexmedetomidine use and length of stay in intensive care, or discharge from hospital (P=0.99 and P=0.54, respectively) and the incidence of delirium in ICU department (P=0.25). Conclusion: Perioperative use of dexmedetomidine was associated with earlier extubation in patients who underwent thoracic and abdominal surgery, without affecting the length of stay in the intensive care unit and hospital. The duration of the operation, old age and the appearance of delirium are the leading factors that contributed to the prolongation of ventilation time. Given the less pronounced depressant effect on noninvasive cardiac output, dexmedetomidine-based perioperative sedation regimens may be an alternative to propofol-based regimens to reduce extubation time |
| Databáze: | OpenAIRE |
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