The effect of sedation on weaning following coronary artery bypass grafting: propofol versus oxycodone-thiopental.

Author(s): Leino K, Nunes S, Valta P, Pikanen O, Vanakoski J, Takala J

Affiliation(s): Department of Anaesthesiology, Turku University Hospital, Finland.

Publication date & source: 2000-04, Acta Anaesthesiol Scand., 44(4):369-77.

Publication type: Clinical Trial; Randomized Controlled Trial

BACKGROUND: Propofol has been advocated for sedation in intensive care because of superior recovery characteristics. We hypothesised that the use of two totally different sedation methods after coronary artery bypass grafting should result in differences not only in extubation time, but also in breathing pattern and gas exchange during weaning and after extubation. METHODS: Thirty patients participated in this randomised and controlled study. We used propofol infusion and oxycodone-thiopental bolus dosage, titrated to sedation level 4 or 5 according to Ramsey. Weaning was performed using protocol-based pressure support trials. RESULTS: Total (SD) fentanyl dose during operation was 33 (6) microg x kg(-1) for propofol and 34 (6) microg x kg(-1) for oxycodone-thiopental (ns). The target sedation was achieved equally with both methods. The time from admission to intensive care unit to extubation was 494 (100) min for propofol and 521 (98) min for oxycodone-thiopental (ns). Weaning times were 63 (24) min and 112 (63) min in the propofol and oxycodone-thiopental groups, respectively (P<0.05). Breathing frequency increased and tidal volume decreased from weaning to 2 h postextubation. CONCLUSION: Propofol infusion and oxycodone-thiopental bolus dosages, titrated to the same sedation end point, resulted in similar time from admission to extubation, although the weaning period was shorter in the propofol group. In terms of breathing pattern, gas exchange, blood gases and haemodynamics, the methods were similar. Propofol, despite its attractive pharmacological profile, may offer no clinical benefit in short-term sedation after a moderate dose fentanyl anaesthesia in cardiac surgery.