Effect of dexmedetomidine or propofol sedation on haemodynamic stability of patients after thoracic surgery

Abstract

Background: Dexmedetomidine and propofol are commonly used sedative agents in non-invasive ventilation as they allow for straightforward arousal and are easily controllable to a relative degree. Moreover, dexmedetomidine is associated with a low risk of respiratory depression. However, both agents are associated with significant haemodynamic side effects. The primary aim of this study is to compare the influence of both drugs on haemodynamic effects in patients after thoracic surgical procedures receiving dexmedetomidine or propofol for non-invasive postoperative ventilation. Methods: A prospective, randomised, observational study conducted in a university hospital. Interventions: Continuous sedation with dexmedetomidine or propofol for six hours of postoperative non-invasive ventilation after thoracic surgery, with concomitant use of continuous epidural analgesia. Results: A total of 38 patients (20 on dexmedetomidine and 18 on propofol) were included in the analysis. The primary findings of this study were that although the heart rate, along with the systolic and mean arterial blood pressure did not differ significantly between the groups (P = 0.87; P = 0.42; P = 0.13, respectively), diastolic arterial blood pressure was significantly higher in the propofol group (P = 0.02). A comparative analysis of epinephrine usage did not reveal significant differences between the groups. Although cardiac output (P = 0.36) and cardiac index (P = 0.36) analyses did not show significant differences between the groups, there is a clear tendency toward lower values of CO/CI in the group receiving propofol. While we also observed a similar tendency in the stroke volume index and stroke volume variation values, these differences did not reach statistical significance either (P = 0.16; P = 0.64, respectively). Despite systemic vascular resistance index values being higher in the propofol group, exceeding reference values, similarly, the difference between the groups was not significant (P = 0.36). Conclusions: The main finding of this study is that dexmedetomidine and propofol provide similar advantages in haemodynamic stability during short-term sedation for non-invasive ventilation after thoracic surgical procedures in patients receiving continuous epidural analgesia.