Abstract
BackgroundAtrial fibrillation occurs frequently in patients following cardiac surgery and can be a cause of increased morbidity and mortality. The use of dexmedetomidine to prevent atrial fibrillation is unclear. The present study was designed to evaluate the effect of dexmedetomidine sedation on the incidence of atrial fibrillation after cardiac surgery.MethodsUpon arrival to the intensive care unit (ICU), cardiac surgery patients without prior atrial fibrillation or flutter were randomized to receive either dexmedetomidine (0.2–1.5 μg/kg/h) or propofol (0.3–3 mg/kg/h) open-label titrated to a target Richmond agitation-sedation scale of 0 to -3. Our primary endpoint was the incidence of postoperative atrial fibrillation, and the secondary end points were the length of ICU stay, length of hospital stay, and hospital costs.ResultsAtrial fibrillation occurred in 6 of 44 patients (13.6 %) in the dexmedetomidine group compared to 16 of 44 patients (36.4 %) in the propofol group (odds ratio = 0.28; 95 % confidence interval, 0.10, 0.80; P = 0.025). The median (interquartile range) length of ICU stay in the dexmedetomidine group was significantly lower than in the propofol group (2.9 (2.4–3.5) vs 3.5 (2.7–4.5 days, P = 0.008), with a trend toward a decrease in median hospital costs (86,367 vs 77,874 Chinese yuan; P = 0.068). The incidence of hypotension was higher in the dexmedetomidine group than in the propofol group (25/44 (56.8 %) vs 13/44 (29.5 %); P = 0.017).ConclusionsDexmedetomidine sedation reduced the incidence of new-onset postoperative atrial fibrillation and shortened the length of ICU stay in patients after cardiac surgery compared to propofol sedation. Dexmedetomidine treatment was associated with more episodes of hypotension.Trial registrationchictr.org.cn: ChiCTR-IPR-16008231, retrospectively registered: April 6, 2016.This trial was not prospectively registered due to a lack of importance applied to trial registration.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1480-5) contains supplementary material, which is available to authorized users.
Highlights
Atrial fibrillation occurs frequently in patients following cardiac surgery and can be a cause of increased morbidity and mortality
After 389 patients were excluded, 90 patients were randomly assigned to two groups: 45 patients received propofol and 45 patients received dexmedetomidine
To our knowledge, the current study is the first prospective randomized trial confirming that dexmedetomidine sedation reduces new-onset postoperative Atrial fibrillation (AF) and shortens the length of intensive care unit (ICU) stay with a trend toward a decrease in hospital costs, compared to propofol sedation
Summary
Atrial fibrillation occurs frequently in patients following cardiac surgery and can be a cause of increased morbidity and mortality. The use of dexmedetomidine to prevent atrial fibrillation is unclear. The present study was designed to evaluate the effect of dexmedetomidine sedation on the incidence of atrial fibrillation after cardiac surgery. Postoperative AF is associated with a prolonged hospital stay, higher costs, and increased morbidity and mortality [4,5,6,7,8]. A number of prophylactic strategies for the prevention of postoperative AF have been proposed, they are not routinely implemented in many clinical centers [9, 10], including ours. The major reasons for non-use include a lack of convincing evidence, potential risks associated with current drug therapies, and complexity of some prevention regimens [11, 12]. Sedatives and analgesics are routinely administered to most patients undergoing cardiac surgery to reduce anxiety and pain
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