Volume 29, Issue 2 (5-2026)
J Arak Uni Med Sci 2026, 29(2): 173-181 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rafiei T, Kamali A R, Hachemi P, Rafiei M, Modir H. : Propofol vs. Dexmedetomidine: Effects on Extubation Time and Length of Stay in ICU/ Hospital After Cardiac Surgery. J Arak Uni Med Sci 2026; 29 (2) :173-181
URL: http://jams.arakmu.ac.ir/article-1-8085-en.html
URL: http://jams.arakmu.ac.ir/article-1-8085-en.html
1- Medical Student of Arak University of Medical Sciences, Arak, Iran
2- Professor, Department of Anesthesiology, Arak University of Medical Sciences, Arak, Iran ,alikamaliir@yahoo.com
3- Assitant Professor, Department of Cardiology, Arak University of Medical sciences, Arak, Iran
4- Professor, Department of Biostatistics, Arak University of Medical Sciences, Arak, Iran
5- Professor, Department of Anesthesiology, Arak University of Medical Sciences, Arak, Iran
2- Professor, Department of Anesthesiology, Arak University of Medical Sciences, Arak, Iran ,
3- Assitant Professor, Department of Cardiology, Arak University of Medical sciences, Arak, Iran
4- Professor, Department of Biostatistics, Arak University of Medical Sciences, Arak, Iran
5- Professor, Department of Anesthesiology, Arak University of Medical Sciences, Arak, Iran
Abstract: (304 Views)
Introduction: As a complex medical intervention, open-heart surgery induces significant physiological alterations, necessitating rigorous pharmacological management in the postoperative phase, especially within the ICU setting. A critical challenge in this patient population involves achieving prompt extubation and hemodynamic stability following cessation of anesthetic drugs. Propofol and dexmedetomidine – commonly employed sedatives during this phase – exhibit distinct pharmacological profiles with comparative benefits and limitations. This investigation was designed to evaluate and contrast the effects of these agents on extubation latency, sedation efficacy, ICU hospitalization duration, and overall hospital stay across both treatment cohort.
Methods: This randomized controlled trial enrolled 92 eligible CABG patients. Using block randomization, participants were assigned to dexmedetomidine or propofol cohorts, with age and sex matching between groups. Primary outcomes comprised Ramsay Sedation Scale assessments, extubation timing following ICU transfer, ICU and hospital lengths of stay, plus mortality/discharge status. Statistical analyses employed R software (version X.X) utilizing comparative intergroup mean tests.
Results: Both cohorts demonstrated age and sex homogeneity. The mean Ramsay Sedation Scale score was significantly lower in the dexmedetomidine group compared to the propofol group (P <0.01). Similarly, post-ICU admission extubation time was significantly reduced in dexmedetomidine recipients versus propofol-treated patients (P< 0.001). No statistically significant difference in mortality distribution was observed between treatment groups (P = 0.45).
Conclusions: This investigation revealed that dexmedetomidine offered significant clinical advantages over propofol in patients undergoing open-heart surgery, demonstrating lower Ramsay Sedation Scale scores (P < 0.01) and significantly reduced extubation times (P < 0.001). These outcomes suggest potential reductions in ICU occupancy and superior recovery profiles. Given its association with expedited extubation, dexmedetomidine represents a viable sedation alternative in post-cardiac surgical care. These findings provide evidence to guide evidence-based sedative selection in cardiac surgery intensive care. Nevertheless, multicenter trials with expanded cohorts are warranted to validate these observations and examine longitudinal clinical trajectories.
Methods: This randomized controlled trial enrolled 92 eligible CABG patients. Using block randomization, participants were assigned to dexmedetomidine or propofol cohorts, with age and sex matching between groups. Primary outcomes comprised Ramsay Sedation Scale assessments, extubation timing following ICU transfer, ICU and hospital lengths of stay, plus mortality/discharge status. Statistical analyses employed R software (version X.X) utilizing comparative intergroup mean tests.
Results: Both cohorts demonstrated age and sex homogeneity. The mean Ramsay Sedation Scale score was significantly lower in the dexmedetomidine group compared to the propofol group (P <0.01). Similarly, post-ICU admission extubation time was significantly reduced in dexmedetomidine recipients versus propofol-treated patients (P< 0.001). No statistically significant difference in mortality distribution was observed between treatment groups (P = 0.45).
Conclusions: This investigation revealed that dexmedetomidine offered significant clinical advantages over propofol in patients undergoing open-heart surgery, demonstrating lower Ramsay Sedation Scale scores (P < 0.01) and significantly reduced extubation times (P < 0.001). These outcomes suggest potential reductions in ICU occupancy and superior recovery profiles. Given its association with expedited extubation, dexmedetomidine represents a viable sedation alternative in post-cardiac surgical care. These findings provide evidence to guide evidence-based sedative selection in cardiac surgery intensive care. Nevertheless, multicenter trials with expanded cohorts are warranted to validate these observations and examine longitudinal clinical trajectories.
Keywords: Dexmedetomidine, Propofol, Extubation, ICU Length of Stay, Hospital Length of Stay, Mortality
References
1. Gu Y, Shan L, Liu B, Lv M, Chen X, Yan T, et al. Release Profile of Cardiac Troponin T and Risk Factors of Postoperative Myocardial Injury in Patients Undergoing CABG. Int J Gen Med. 2021;14:2541-51. pmid: 34163222 doi: 10.2147/IJGM.S315691
2. Shaefi S, Mittel A, Loberman D, Ramakrishna H. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting-A Systematic Review and Analysis of Clinical Outcomes. J Cardiothorac Vasc Anesth. 2019;33(1):232-44. pmid: 29753665 doi: 10.1053/j.jvca.2018.04.012
3. Rezaei Y, Peighambari MM, Naghshbandi S, Samiei N, Ghavidel AA, Dehghani MR, et al. Postoperative atrial fibrillation following cardiac surgery: from pathogenesis to potential therapies. Am J Cardiovasc Drugs. 2020;20(1):19-49. pmid: 31502217 doi: 10.1007/s40256-019-00365-1.
4. Elgebaly AS, Sabry M. Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery. Ann Card Anaesth. 2018;21(3):235-42. pmid: 30052208 doi: 10.4103/aca.ACA_168_17
5. Euteneuer AA, Radosevich MA, Weingarten TN, Seelhammer TG, Schroeder D, Wittwer ED. Dexmedetomidine versus propofol for postoperative recovery after cardiac surgery: a historical cohort study. Can J Anaesth. 2025;72(3):409-16. pmid: 39562427 doi: 10.1007/s12630-024-02877-0
6. Uddin S, Ali S, Farook N, Rasool B, Phull Q, Talib S. Comparison of Dexmedetomidine and Propofol Among Mechanically Ventilated Postsurgical Patients. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University. 2024;20(Suppl 1).:469-73 doi:10.48036/apims.v20iSUPPL- .1165
7. Ruan H, Li W, Wang J, Chen G, Xia B, Wang Z, Zhang M. Propofol alleviates ventilator-induced lung injury through regulating the Nrf2/NLRP3 signaling pathway. Exp Mol Pathol. 2020;114:104427. pmid: 32199914 doi: 10.1016/j.yexmp.2020.104427
8. Tang C, Li Y, Lai Y. Intraoperative Dexmedetomidine for Prevention of Postoperative Cognitive Dysfunction and Delirium in Elderly Patients with Lobectomy: A Propensity Score-Matched, Retrospective Study. Int J Gen Med. 2024;17:2673-80. pmid: 38863738 doi: 10.2147/IJGM.S456762
9. Yang L, Cai Y, Dan L, Huang H, Chen B. Effects of dexmedetomidine on pulmonary function in patients receiving one-lung ventilation: a meta-analysis of randomized controlled trial. Korean J Anesthesiol. 2023;76(6):586-96. pmid: 36924790 doi: 10.4097/kja.22787
10. Ueki M, Kawasaki T, Habe K, Hamada K, Kawasaki C, Sata T. The effects of dexmedetomidine on inflammatory mediators after cardiopulmonary bypass. Anaesthesia. 2014;69(7):693-700. pmid: 24773263 doi: 10.1111/anae.12636.
11. Guo XN, Ma X. The effects of propofol on autophagy. DNA Cell Biol. 2020;39(2):197-209. pmid: 31880481 doi: 10.1089/dna.2019.4745
12. Elgendy M, Marzouk S, Samir E, Gendy B, Abbas S, Ahmed A, Ali N. Propofol Versus Dexmedetomidine for Postoperative Nausea and Vomiting in Ureteroscopic Procedures Under Spinal Anesthesia: A Randomized, Placebo-Controlled Clinical Trial. Arch Anesth & Crit Care. 2026;12(1):18-25. doi: 10.18502/aacc.v12i1.20536
13. Mohamed Ibrahim A, Said ElSharkawy M, Khalil Abdelrahman R, Elabd Hassan A, Gaber Ibrahim Saad M, Ahmed Elzoughari I, et al. Comparing the Sedative Effect of Dexmedetomidine and Propofol in Mechanically Ventilated Patients Using Salivary Alpha-Amylase as a Stress Marker: A Randomized Open-Label Trial. Anesth Pain Med. 2024;14(5):e149364. pmid: 40689106 doi: 10.5812/aapm-149364
14. Pourya Adibi AH, Mehrdad Malekshoar, Majid Vatankhah. Comparison of the effect of intravenous dexmedetomidine and midazolam on hemodynamic and respiratory mechanic in patients under mechanical ventilation in the intensive care unit of Bandar Abbas Shahid Mohammadi Hospital, 2020. Journal of Practical Emergency Medicine. 2022;9(1):9.
15. Joe HB, Chae YJ, Song SH, Yi IK. Comparison of the effects of dexmedetomidine and propofol on the cardiovascular autonomic nervous system during spinal anesthesia: preliminary randomized controlled observational study. Journal of Clinical Monitoring and Computing. 2023;37(6):1541-51. pmid: 37572236 doi: 10.1007/s10877-023-01062-w
16. Preveden M, Zdravković R, Vicković S, Vujić V, Todić M, Mladenović N, et al. Dexmedetomidine vs. propofol sedation reduces the duration of mechanical ventilation after cardiac surgery - a randomized controlled trial. Eur Rev Med Pharmacol Sci. 2023;27(16):7644-52. pmid: 37667942 doi: 10.26355/eurrev_202308_33418
17. Mustari N, Bhaire VS, Rao BS, Sandhya N, Abu Taha MA. Comparative study of efficacy of dexmedetomidine and propofol for sedation in intensive care unit. nternational Journal of Advances in Medicine. 2025;12(4):382–6. doi:10.18203/2349-3933.ijam20251936
18. Hemphill S, McMenamin L, Bellamy MC, Hopkins PM. Propofol infusion syndrome: a structured literature review and analysis of published case reports. Br J Anaesth. 2019;122(4):448-59. pmid: 30857601 doi: 10.1016/j.bja.2018.12.025.
19. Bangash R, Ahmad I, Naz U, Islam MU, Zeb A, Shah NA, et al. Comparison of efficacy between dexmedetomidine and propofol after coronary artery bypass graft surgery. Biological and Clinical Sciences Research Journal. 2024;2024(1):849. doi:10.54112/bcsrj.v2024i1.849
20. Zimmermann S, Hollinger A, Achermann R, von Felten S, Sutter R, Rüegg S, et al. Comparison of Propofol and Dexmedetomidine Infused Overnight to Treat Hyperactive and Mixed ICU Delirium: A Prospective Randomised Controlled Clinical Trial. J Clin Med. 2025;14(12):4348. pmid: 40566093 doi: 10.3390/jcm14124348
21. Abdallah O, Salem MI, Gomaa M. Dexmedetomidine versus propofol in reducing atrial fibrillation after cardiac surgery. Egyptian Journal of Anaesthesia. 2022;38(1):72-7. doi: 10.1080/11101849.2021.2023313
22. Heybati K, Zhou F, Ali S, Deng J, Mohananey D, Villablanca P, Ramakrishna H. Outcomes of dexmedetomidine versus propofol sedation in critically ill adults requiring mechanical ventilation: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth. 2022;129(4):515-26. pmid: 35961815 doi: 10.1016/j.bja.2022.06.020
23. Patil VP, Abraham J, George GM. Comparing dexmedetomidine and propofol for sedation and hemodynamic stability in cardio-thoracic intensive care unit for patients following off-pump coronary artery bypass graft surgery. International Journal of Basic & Clinical Pharmacology. 2021;10(2):153-9. doi: 10.18203/2319-2003.ijbcp20210085
24. Propofol Dosage. Available from: https://reference.medscape.com/drug/diprivan-propofol-343100.
25. Dexmedetomidine Dosage. Available from: https://reference.medscape.com/drug/precedex-igalmi-dexmedetomidine-342932.
26. Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice- a review. J Clin Diagn Res. 2014;8(10):GE01–GE04. pmid: 25478365 doi: 10.7860/JCDR/2014/9624.4946
27. Abowali HA, Paganini M, Enten G, Elbadawi A, Camporesi EM. Critical review and meta-analysis of postoperative sedation after adult cardiac surgery: dexmedetomidine versus propofol. J Cardiothorac Vasc Anesth. 2021;35(4):1134-42. pmid: 33168430 doi: 10.1053/j.jvca.2020.10.022
28. Nguyen J, Nacpil N. Effectiveness of dexmedetomidine versus propofol on extubation times, length of stay and mortality rates in adult cardiac surgery patients: a systematic review and meta-analysis. JBI Database System Rev Implement Rep. 2018;16(5):1220-39. pmid: 29762314 doi: 10.11124/JBISRIR-2017-003488
29. Liu X, Xie G, Zhang K, Song S, Song F, Jin Y, Fang X. Dexmedetomidine vs propofol sedation reduces delirium in patients after cardiac surgery: A meta-analysis with trial sequential analysis of randomized controlled trials. J Crit Care. 2017;38:190-6. pmid: 27936404 doi: 10.1016/j.jcrc.2016.10.026
30. Kumar N, Kumar A, Kumar A, Hussain M, Kumar A. Comparison between dexmedetomidine and propofol for sedation during mechanically ventilated patients after major intraabdominal surgeries: An observational study. Indian J Clin Anaesth. 2018;5(2):210-5. doi: 10.18231/2394-4994.2018.0039
31. Hu J, Lv B, West R, Chen X, Yan Y, Pac Soo C, Ma D. Comparison between dexmedetomidine and propofol on outcomes after coronary artery bypass graft surgery: a retrospective study. BMC Anesthesiol. 2022;22:51. pmid: 35183122 doi: 10.1186/s12871-022-01589-6
32. Pereira JV, Sanjanwala RM, Mohammed MK, Le ML, Arora RC. Dexmedetomidine versus propofol sedation in reducing delirium among older adults in the ICU: A systematic review and meta-analysis. Eur J Anaesthesiol. 2020;37(2):121-31. pmid: 31860605 doi: 10.1097/EJA.0000000000001131
33. Aghdaii N, Yazdanian F, Faritus SZ. Sedative efficacy of propofol in patients intubated/ventilated after coronary artery bypass graft surgery. Anesth Pain Med. 2014;4(1):e17109. pmid: 24660162 doi: 10.5812/aapm.17109.
34. Ahmad N, Naseem C, Naeem F, Shahid O, Ali Shah T, Ahmad Tariq SM, Saleem A. Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery; a cross sectional study. Indus Journal of Bioscience Research. 2025;3(1):596-603.doi: 10.70749/ijbr.v3i1.568
35. Djaiani G, Silverton N, Fedorko L, Carroll J, Styra R, Rao V, Katznelson R. Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology. 2016;124(2):362-8. pmid: 26575144 doi: 10.1097/ALN.0000000000000951
36. Ji F, Li Z, Nguyen H, Young N, Shi P, Fleming N, Liu H. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation. 2013;127(15):1576-84. pmid: 23513068 doi: 10.1161/CIRCULATIONAHA.112.000936
37. Curtis JA, Hollinger MK, Jain HB. Propofol-based versus dexmedetomidine-based sedation in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2013;27(6):1289-94. pmid: 24011878 doi: 10.1053/j.jvca.2013.03.022
38. Ji F, Li Z, Young N, Moore P, Liu H. Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2014;28(2):267-73. pmid: 24182835 doi: 10.1053/j.jvca.2013.06.022
39. Brandão PGM, Lobo FR, Ramin SL, Sakr Y, Machado MN, Lobo SM. Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study. Braz J Cardiovasc Surg. 2016;31(3):213-8. pmid: 27737403 doi: 10.5935/1678-9741.20160043
40. Liu H JF, Peng K, Applegate RL. Sedation After Cardiac Surgery: Is One Drug Better Than Another? Anesth Analg 2017;124(4):1061-70. pmid: 27984229 doi: 10.1213/ANE.0000000000001588
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
