Comparing the Efficacy and Safety of Dexmedetomidine Versus Propofol for Sedation in Adult Patients Undergoing Cardiac Procedures: A Systematic Review.

Operative cardiac procedures require meticulous sedation management to optimize patient outcomes. Two commonly used sedatives in these procedures are dexmedetomidine and propofol. Propofol is a γ-aminobutyric acid (GABA) agonist widely used for its rapid onset of action and short recovery time. Dexmedetomidine is an α₂-adrenoceptor agonist that provides sedation with minimal respiratory depression due to its opioid-sparing effect. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to compare dexmedetomidine and propofol in adult patients undergoing cardiac procedures. A comprehensive literature search identified 648 studies that were screened down to a total of 15 that met the inclusion criteria. The included studies assessed hemodynamic stability, sedation effectiveness, postoperative recovery, incidence of adverse effects, and other relevant parameters. Findings revealed distinctive hemodynamic profiles between these two sedative agents. Dexmedetomidine administration was associated with clinically significant reductions in heart rate and mean arterial pressure, which ultimately requires vigilant monitoring for bradycardic and hypotensive episodes. In contrast, propofol demonstrated greater hemodynamic variability and was linked to higher incidences of cardiac arrhythmias as well as elevated postoperative analgesic requirements. It was also found that dexmedetomidine facilitated significantly reduced extubation times, decreased mechanical ventilator dependency, and markedly lower rates of postoperative delirium. These findings point to dexmedetomidine as a potentially advantageous option for enhanced recovery protocols in cardiac anesthesia. Propofol remains a widely used alternative due to its predictable recovery profile, but its association with increased opioid use and hemodynamic instability may limit its benefits in certain patient populations. The choice between these agents should be guided by individualized sedation strategies that balance the need for hemodynamic stability, depth of sedation, and optimization of recovery. Further research is warranted to explore long-term outcomes and refine best practices for sedation in patients undergoing cardiac procedures.