Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study

Article Information

Title: Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study

Authors: Noor-Ul- Ain, Syed Muzaffar r Hasan Kirmani, Ayesha Siddique, M Umer Siddique, Rehana Javaid, M Aamir Khan

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2022

Volume: 72

Issue: Supplementary 3

Language: English

DOI: 10.51253/pafmj.v72iSUPPL-3.9562

Keywords: DexmedetomidineCardiac SurgeryPost-operative delirium

Abstract

Objective: To find out the frequency of delirium associated with peri-operative use of dexmetedomidine and propofol in post CABG patients.
Study Design: Comparative Cross-sectional study.
Place and Duration of Study: Adult Intensive Care unit, Department of Cardiac Anesthesiology and Intensive Care, Armed Force Institute of Cardiology, Rawalpindi Pakistan from Feb to Jun 2022.
Methodology: All post CABG patients who have undergone elective surgery were included through non-probability consecutive sampling technique. All the delirious patients amongst them were subjected to a modified version of ICU-CAM to establish post-operative delirium (POD) caused by either dexmedetomidine or propofol. POD in both the category of patients was compared.
Results: A total of 179 CABG patients were included in our study. 140(78.2%) of the patients were subjected to the use of dexmedetomidine throughout their surgery while 39(21.8%) of the patients were given propofol. After subjecting the patients to our exclusion criteria which aimed to eliminate the confounding causes of POD in post-CABG patients, only 30(16.8%) had delirium while 149(83.2%) didn’t develop delirium (p-value=0.003). Majority of the delirious patients were given dexmedetomidine (n=29; 20.77%) in the operation theatre while only a fraction (n=1; 2.58%) were given propofol. Average duration of ICU stay in our study population was 5 days. 15(8.4%) cases out of our total study population underwent reintubation and re-ventilation because of low cardiac output or respiratory distress.
Conclusion: Dexmedetomidine could possibly be associated with POD in patients undergoing cardiac surgery. Propofol on the other hand is considerably safe in this regard and doesn’t cause POD.

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Research Objective

To find out the frequency of delirium associated with peri-operative use of dexmedetomidine and propofol in post-CABG patients.

Methodology

Comparative cross-sectional study conducted in the Adult Intensive Care Unit of the Armed Forces Institute of Cardiology, Rawalpindi, Pakistan, from February to June 2022. Elective CABG patients aged 35-85 years who received either dexmedetomidine or propofol were included. Post-operative delirium (POD) was assessed using a modified ICU-CAM. Exclusion criteria were applied to eliminate confounding causes of POD. Data was analyzed using descriptive statistics, Chi-square test, and T-test.

Methodology Flowchart

                        graph TD
    A["Obtain Institutional Review Board Approval"] --> B["Select Elective CABG Patients 35-85 years"];
    B --> C["Administer Dexmedetomidine or Propofol"];
    C --> D["Monitor Patients Post-operatively"];
    D --> E["Assess for Delirium using modified ICU-CAM"];
    E --> F["Apply Exclusion Criteria"];
    F --> G["Collect and Analyze Data"];
    G --> H["Compare Delirium Frequency"];
    H --> I["Formulate Conclusion"];

Discussion

The study suggests a possible association between dexmedetomidine use and post-operative delirium (POD) in CABG patients, contrasting with propofol, which appeared safe in this regard. The findings align with some research indicating dexmedetomidine as a potential cause of POD, while acknowledging conflicting literature. The high incidence of delirium in diabetic and hypertensive patients highlights the multifactorial nature of POD.

Key Findings

Out of 179 CABG patients, 140 (78.2%) received dexmedetomidine and 39 (21.8%) received propofol. A total of 30 (16.8%) patients developed delirium, with 29 (20.71%) of those receiving dexmedetomidine and 1 (2.56%) receiving propofol. This difference was statistically significant (p-value = 0.003). The majority of delirious patients were diabetic (93.3%) and hypertensive (76.6%).

Conclusion

Dexmedetomidine may be associated with post-operative delirium in patients undergoing cardiac surgery. Propofol is considered a safe sedative drug for this patient population and may help reduce the overall incidence of POD.

Fact Check

* The study included 179 CABG patients.
* 16.8% of the total study population developed delirium.
* 29 out of 30 delirious patients received dexmedetomidine.

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