Combined Propofol and Dexmedetomidine Is Associated with Lower Mortality but Not Delirium After Cardiovascular
Mitsuhiro Tamoto1, Shinichi Kai2, Hisako Yoshida3
1Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan; Department of Nursing, Kyoto University Hospital, Kyoto, Japan.
Objectives:
To compare the real-world effectiveness of combined propofol and dexmedetomidine (PRODEX) sedation with propofol monotherapy on survival and postoperative delirium (POD) in a large nationwide cohort of patients undergoing cardiovascular surgery.
Design:
A retrospective cohort study.
Setting:
Data from a Japanese nationwide administrative claims database, including more than 400 acute care hospitals.
Participants:
There were 23,629 patients, including 9,671 PRODEX users and 13,958 propofol users.
Intervention:
None.
Measurements And Main Results:
The primary outcome was 28-day mortality. The secondary outcomes were 90-day mortality and POD incidence. PRODEX users were associated with lower 28-day mortality (hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.63-0.93; p < 0.01) and 90-day mortality (HR 0.82; 95% CI 0.69-0.96; p = 0.01) compared with propofol users. The Fine and Gray model showed no significant difference in the POD risk between PRODEX users and propofol users (subdistribution HR, 1.01; 95% CI 0.94-1.08; p = 0.81).
Conclusions:
This large-scale, real-world study found that PRODEX was associated with a significant decrease in 28- and 90-day mortality. However, PRODEX did not reduce the incidence of POD compared to propofol monotherapy.
More Related Videos
Related Concept Videos
01:24Parenteral Anesthetics: Overview
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:22Stages of General Anesthesia
01:17Sedatives and Hypnotics Drugs: Miscellaneous Agents
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
01:23Sedatives and Hypnotics: Overview
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
01:20Sedatives and Hypnotics Drugs: Barbiturates