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Educated Hand Publishing LLC 
“The Science Behind the Art” 
Volume 8 - No.4 2020 

 Anesthesia eJournal - Online
ISSN 2333-2611

Page 12

Dexmedetomidine vs Propofol for Cardiopulmonary Bypass
Jinah Leazenby, BSN, RN, CCRN
Affiliation:
Texas Christian University

Funding/Conflict of Interest Disclosure: 
None

KEYWORDS:  Cardiopulmonary bypass; dexmedetomidine; propofol; post-operative delirium; cerebral regional tissue oxygen 
saturation

Abstract
Propofol has been used as part of balanced anesthetic in cardiovascular surgery patients. Dexmedetomidine is newer 
agent with multiple benefits and may be superior than propofol.   
A 68-year-old male with history of CAD, GERD, T2DM, OSA, was undergoing an elective coronary bypass graft 
surgery. The patient in this case report received dexmedetomidine infusion throughout the procedure as well as 
postoperatively. Patient maintained cerebral oximetry > 50, did not suffer from arrythmias, his hemodynamic was stable, 
his ICU course was short, and patient was also extubated in 2 hours after arrival to the unit. In addition, patient did 
not suffer from post-operative delirium. Dexmedetomidine infusion during cardiac surgery may be superior to propofol 
infusion due to better prevention of ventricular arrythmia, hemodynamic stability, reducing length of mechanical 
ventilation and ICU stay, and prevention of postoperative delirium.

AEJ



Educated Hand Publishing LLC 
“The Science Behind the Art” 
Volume 8 - No.4 2020 

 Anesthesia eJournal - Online
ISSN 2333-2611

Page 13

PowerPoint Template ©2009 Texas Christian University, Center for Instructional Services. For Educational Use Only. Content is the property of the presenter and their resources.

Introduction 
• Cardiovascular surgery poses increased risk for 

several complications including neurologic insult, 
postoperative dysrhythmias, cognitive disorders, 
myocardial ischemia, stroke, coma, heart block, 
acute renal failure, increased ICU stay and prolonged 
mechanical ventilation.2-6

• Dexmedetomidine has emerged in the maintenance 
of anesthesia during cardiac surgery as compared to 
propofol.2-6

Purpose
• This case study will review both agents to see if one 

is superior in providing better hemodynamic stability 
and patient outcomes while undergoing 
cardiopulmonary bypass. 

Discussion

• The patient in this case report received dexmedetomidine 
infusion throughout the procedure as well as 
postoperatively. Due to the infusion, volatile anesthetic and 
opioid requirement were reduced. Patient was also able to 
remain calm while on ICU ventilator. 

• Both propofol and dexmedetomidine preserve cerebral O2 
saturation.2 The patient also maintained cerebral oximetry 
WNL (rSCO2> 50) during this case. 

• Dexmedetomidine does decrease ventricular dysrhythmias 
(eg PVC, VT) compared to propofol.3,6 The patient in this 
case report did not suffer from atrial or ventricular 
dysrhythmias. 

• Dexmedetomidine has better hemodynamic stability.4 This 
was also true in this case study, patient maintained heart 
rate & BP during incision and sternotomy. 

• Dexmedetomidine has been associated with reduced ICU 
stay and decreased prolonged mechanical ventilation.4 The 
patient in this case study was extubated 2 hours after 
arrival to the unit without complications. 

• Dexmedetomidine has been shown to be superior to other 
agents in preventing postoperative delirium (eg, 
midazolam, propofol, opioids, ketamine).5 The patient in 
this case study had normal neurologic exam 
preoperatively(A&OX4). 3-hour postoperative exam (1 hour 
post-extubation) was normal without evidence of 
delirium(A&OX4). 

Dexmedetomidine vs Propofol for Cardiopulmonary Bypass
Jinah Leazenby, BSN, RN, CCRN Texas Christian University

Preanesthetic Evaluation

• 68-year-old, 85 kg, 180 cm, male CABG x3.
• PMH: CAD, GERD, T2DM, HTN, OSA, Angina.
• PSH: L knee arthroplasty (SAB -->without anesthesia 

complications)
• Cardiac Cath report: LHC: 60% stenosis of prox. LAD, 60% 

stenosis of RIA, 70% stenosis of OM1, ECHO: EF=60% without 
evidence of significant stenosis or regurgitation of valves.  

• Pertinent labs: H/H: 14.0/42, PLT 325
• Pre-Op VS: BP 140/87 mmHg, HR 85, O2Sat 100%, RR 12, 

36.8°C. 
• Airway assessment: MP2, FROM of neck, TMD < 3FB, ULBT Class 

I, >3FB mouth opening  
• Anesthetic Plan: GETA with standard ASA monitors, A line, central 

line, PA catheter, and cerebral saturation monitor. 

Intraoperative Anesthetic Management

• Monitors: Standard plus pre-induction A-line, PAC, foley catheter.
• Induction: Preoxygenation, IV induction: lidocaine 100 mg, 

fentanyl 100 mcg, etomidate 14 mg, propofol 50mg, and 
succinylcholine 130 mg, Miller 2, Grade I view, 8.0 ETT.

• Maintenance: Sevoflurane Et 0.9-1.3% in a mixture of O2 1 L/min 
and dexmedetomidine infusion at 0.3mcg/kg/hr. Norepinephrine 
infusion titrated for MAP goal of 70mmHg. 2

• On Pump: dexmedetomidine 0.3mcg/kg/hr only
• Off Pump: 250mL of 5% albumin and epinephrine infusion 

0.01mcg/kg/min for CI goal 2.2. Norepinephrine was continued at 
0.3mcg/kg/min.  2300mL cellsaver blood administered. Patient 
received total of 1000 mcg of fentanyl and 250mcg of sufentanil. 
Plasma glucose maintained with insulin drip 1-3U/hour  

• Cerebral oximetry monitoring WNL 
• Case Totals: 2000mL crystalloid, UOP 1100 mL, EBL 100mL, 5 

hours of anesthesia time.
• Patient remained intubated and transferred to ICU on 

dexmedetomidine at 0.4mcg/kg/hr and norepinephrine at 
0.03mcg/kg/min. 

Postoperative Evaluation

• PostOp VS: BP 114/72 mmHg, HR 76, O2Sat 100%, RR 16, and 
temperature 36.7°C. 

• The patient was extubated 2 hours post arrival to ICU, remained 
free of complications and postoperative delirium. Discharged to 
home on POD day 5. 

References
1.Rathmell JP, Rosow CE. Intravenous sedatives and hypnotics. In: Flood P, Rathmell JP, Shafer S. 
Stoelting’s Pharmacology & Physiology in Anesthetic Practice. 5th ed. Philadelphia, PA, Wolters Kluwer 
Health.; 2015
2. Metry AA, Hussain NS, Nakhla GM, Ragaei MZ, Wahba RM. The effect of continuous propofol versus 
dexmedetomidine infusion on regional cerebral tissue oxygen saturation during cardiopulmonary bypass. 
Rom J Anaesth Intensive Care. 2019;26(1):17-23.
3. Zhu Z, Zhou H, Ni Y, Wu C, Zhang C, Ling X. Can dexmedetomidine reduce atrial fibrillation after 
cardiac surgery? A systematic review and meta-analysis. Drug Des Devel Ther. 2018;12:521-531.
4. Sheikh TA, Dar BA, Akhter N, Ahmad N. A Comparative Study Evaluating Effects of Intravenous 
Sedation by Dexmedetomidine and Propofol on Patient Hemodynamics and Postoperative Outcomes in 
Cardiac Surgery. Anesth Essays Res. 2018;12(2):555-560.
5. Pieri M, De Simone A, Rose S, et al. Trials Focusing on Prevention and Treatment of Delirium After 
Cardiac Surgery: A systematic Review of Randomized Evidence. J Cardiothorac Vasc Anesth. 2019.
6. Ling X, Zhou H, Ni Y, Wu C, Zhang C, Zhu Z. Does dexmedetomidine have an antiarrhythmic effect on 
cardiac patients? A meta-analysis of randomized controlled trials. PLoS One. 2018;13(3):e0193303.
7. Tufail SA, Ahmad N, Akhter N. Comparative Analysis of Dexmedetomidine and Propofol Based 
Sedation Regimens on Anaesthetic Requirements in Cardiac Surgery with On-pump Cardiopulmonary 
Bypass. Journal of Clinical and Diagnostic Research. 2018.

Conclusion
• Dexmedetomidine infusion during cardiac surgery may be 

superior to propofol infusion in preventing ventricular 
dysrhythmias, providing better hemodynamic stability, 
reducing length of mechanical ventilation and ICU stay, 
opioid and anesthetic sparing property, and preventing of 
postoperative delirium.1-7

Pharmacology Review
Dexmedetomidine Propofol 

MOA1 • Potent alpha 2 adrenergic agonist (a2:a1 = 
1620: 1) works by inhibiting pontine locus 
ceruleus causing decrease in SNS activity 
and level of arousal causing sedation

• GABAA agonist leading to decrease rate of 
dissociation of inhibitory neurotransmitter. 
(prolongs duration of hyperpolarization of cell 
membrane of chloride channel when GABA 
binds)

CV1 • Hypotension & bradycardia • Hypotension & blunted tachycardic response to 
hypotension

Neuro1 • Decrease CBF& no change in CMRO2
• Neuroprotective

• Decrease in CBF & CMRO2

Pharmacokinetic1 • Highly protein bound
• Hepatic metabolism/kidney excretion

• Clearance of propofol from plasma > hepatic BF
• Hepatic metabolism/kidney excretion

Uses1 • Attenuating hemodynamic response to 
intubation

• Decrease catecholamine level intraop
• Decrease periop requirement for inhaled 

anesthetic and opioid
• Potential anesthetic of choice for difficult 

airway, post-op shivering and post op 
sedation 

• Induction of anesthesia
• IV sedation
• Maintenance of anesthesia 
• Antiemetic 
• Antipruritic
• Anticonvulsant
• Attenuation of bronchoconstriction.

Literature Review
Dexmedetomidine Propofol 

Cerebral tissue O2 Sat2 • No significant decrease in rScO2 & 
mini-mental state exam

• neuroprotective  

No significant decrease in rScO2 & 
mini-mental state exam
Neuroprotective

Hemodynamic stability4 • Lower percentage of increase in HR, 
SBP, DBP was noted at skin incision 
and sternotomy

• Same pressor requirement

• Same pressor requirement 

Length of stay in ICU & length of 
mechanical ventilation4

• ICU stay: 92 hours
• Post op ventilation: 5.9 hours

• ICU stay : 133.46 hours
• Post op ventilation: 8.6 hours

Post op arrythmia3,6 • Not shown to reduce A fib
• Shown to reduce VT

• Not shown to reduce A fib

Post op delirium5 • Systematic review of 56 articles showed dexmedetomidine to be superior 
pharmacologic agent in preventing postop delirium when compared to other 
pharmacologic agents such as propofol, ketamine, and opioids. 

Introp opioid and anesthetic 
sparing property7

• 13.1 mg total required on average 
during intraop

• Lower MAC of isoflurane requirement 
to maintain BIS of 40-60

• 16.05mg total required on average 
during intraop


