To Evaluate Dexmedetomidine as an Additive to Propofol for Sedation for Elective Cardioversion in a Cardiac Intensive Care Unit: A Double-blind Randomized Controlled Trial

INTRODUCTION: Propofol may lead to patient recall and discomfort when used for sedation in elective cardioversion. The aim of the present study was to evaluate dexmedetomidine as an additive to propofol for sedation in elective cardioversion. MATERIALS AND METHODS: A total of 500 patients undergoing elective cardioversion were randomized into Group 1 (n = 250) and Group 2 (n = 250) on the basis of computer-generated randomization table. Patients in Group 1 were given dexmedetomidine (1 mcg/kg) over 10 min before giving propofol (1 mg/kg), while patients in Group 2 were given only propofol (1 mg/kg). One or two additional doses of 0.5 mg/kg propofol were given if modified Ramsay Sedation Score (mRSS) was <5. Number of patients requiring additional doses were noted. Any hemodynamic or respiratory complication along with the mean time to recovery (mRSS = 1) was recorded. Patient recall, patient discomfort, and further requirement of cardioversion in the next 24 h were also noted. RESULTS: About 10% patients in Group 1 and 64% patients in Group 2 required the first additional dose of propofol. While no patient in Group 1 required second dose, 16% patients in Group 2 required second dose of propofol. The mean time to recovery in Group 1 was 8.36 ± 3.08 min and 8.22 ± 2.38 min in Group 2 (P = 0.569). Sixty-seven patients (26.8%) in Group 1 and 129 patients (51.6%) in Group 2 reported remembering something (P < 0.0001), i.e., recall. Thirty-five patients (14%) in Group 1 and 79 patients (31.6%) in Group 2 reported dreaming during the procedure (P < 0.0001). Visual analog scale score was higher in Group 1 as compared to Group 2. Six patients in Group 1 and 24 patients in Group 2 had a requirement of repeat cardioversion in 24-h follow-up (P = 0.001). CONCLUSIONS: Dexmedetomidine is a useful adjunct to propofol for elective cardioversion.