Postoperative short-term sedation with propofol in cardiac surgery

We conducted a randomized double-blind study to assess the safety and effec tiveness of short-term sedation with propofol in adult patients immediately after cardiac surgery. Sixty hemodynamically stable adult patients who und erwent cardiac surgery were randomly assigned to receive propofol postopera tively or no postoperative sedation. The propofol group (n = 30) received p ropofol infusion (1 mg.kg(-1).hr(-1)) immediately after they awoke postoper atively. The infusion rates were adjusted to maintain a sedation level (Ram say score) of 3. Nurses assessed the effectiveness of the sedation accordin g to Ramsay scores; the patients also subjectively evaluated sedation. Post operative pulmonary oxygenation dysfunction (PaO2/FiO(2) <300 mm Hg) was no ted in 10 patients receiving propofol and in eight patients in the control group. The dysfunction was greatly improved after overnight ventilator supp ort, and this improvement was not affected by propofol sedation. The propof ol group received an average of 13.6 +/- 5.3 hours of propofol infusion, at an average infusion rate of 0.96 +/- 0.16 mg.kg(-1).hr(-1). Patients recei ving propofol remained well sedated (Ramsay score greater than or equal to 2) during 99.3% of the study period, while the control patients remained an xious or agitated (Ramsay score, 1) during 12% of the study period. Patient s receiving propofol were successfully extubated 9 +/- 4 minutes after cess ation of propofol infusion, without complications. The turnover of intensiv e care unit beds was not delayed by propofol sedation. Subjective evaluatio ns (scored on an analog scale: 0 = nil, 10 = extreme) revealed that patient s receiving propofol felt less pain than those in the control group (2.3 +/ - 2.7 vs 4.7 +/- 3.1, p < 0.05), had better sleep quality (7.8 +/- 2.9 vs 5 .1 +/- 2.9, p < 0.05), and were more satisfied with the care they received (8.3 +/- 2.2 vs 5.8 +/- 3.9, p < 0.05). These findings suggest that propofo l infusion is effective for short-term sedation of cardiac surgery patients postoperatively and that an infusion rate adequate to maintain a Ramsay sc ore of 3 may be ideal. Postoperative sedation should be considered for all cardiac surgery patients, not only those with outward signs of anxiety or a gitation.