Wake-up times following sedation with sevoflurane versus propofol after cardiac surgery

Abstract

Objectives. Intravenous sedation in the intensive care unit (ICU) may contribute to altered consciousness and prolonged mechanical ventilation. We tested the hypothesis that replacing intravenous propofol with inhaled sevoflurane for sedation after cardiac surgery would lead to shorter wake-up times, quicker patient cooperation, and less delusional memories. Design. Following coronary artery bypass surgery with cardiopulmonary bypass, 100 patients were randomized to sedation with sevoflurane via the anesthetic conserving device or propofol. Study drugs were administered for a minimum of 2 hours until criteria for extubation were met. Primary endpoints were time from drug stop to extubation and to adequate verbal response. Secondary endpoints were adverse recovery events, memories reported in the ICU Memory Tool test, and ICU/hospital stay. Results. Median time from drug stop to extubation (interquartile range/total range) was shorter after sevoflurane compared to propofol sedation; 10 (10/100) minutes versus 25 (21/240) minutes (p <0.001). Time from extubation to adequate verbal response was shorter (p =0.036). No differences were found in secondary endpoints. Conclusions. Sevoflurane sedation after cardiac surgery leads to shorter wake-up times and quicker cooperation compared to propofol. No differences were seen in ICU-stay, adverse memories or recovery events in our short-term sedation.

Key words::

• randomized controlled trial
• sevoflurane
• propofol
• sedation
• postoperative period
• extubation
• memories

Acknowledgements

We thank Registered Nurse Helena Pietrzyk at the surgical ward and all nurses at the ICU for invaluable help in conducting this study.

Declaration of interest: The regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet provided financial funding. Part of the funding was also provided by Lena and Per Sjöberg scholarship. Abbott Scandinavia AB sponsored purchase of sevoflurane (Sevorane^®) and Sedana Medical AB supplied the anesthetic conserving device (AnaConDa^®). Peter Sackey has received honoraria as a lecturer for Abbott Scandinavia AB and has been an Advisory Board participant for Baxter International Inc. The other authors state no conflicts of interest. The authors alone are responsible for the content and writing of the paper.