Effects of Volatile Sedation Versus Propofol on Time to Extubation in the Intensive Care Unit After Cardiac Surgery: A Systematic Review and Meta-analysis.

Abstract

Background: Optimal sedation management is critical in the postoperative care of cardiac surgery patients admitted to the intensive care unit (ICU), where sedative choice may influence respiratory, hemodynamic, and recovery outcomes. Propofol is the most widely used sedative, but volatile anesthetics are gaining interest due to their pharmacologic advantages. This systematic review and meta-analysis was designed to compare volatile anesthetics with propofol for ICU sedation after cardiac surgery, focusing on time to extubation as the primary outcome, and ICU and hospital length of stay, hemodynamic support, and postoperative complications as secondary outcomes.

Methods: PubMed, Web of Science, and Scopus were searched from July to October 2024 without language or date restrictions. Eligible studies were randomized controlled trials comparing volatile anesthetics with propofol for postoperative ICU sedation in adult cardiac surgery patients. Studies without extractable data were excluded. Risk of bias was assessed using the Cochrane risk-of-bias 2.0 tool. Meta-analyses were performed using random-effects models.

Results: Five randomized controlled trials involving 384 patients were included. Sedation with volatile anesthetics significantly reduced time to extubation compared with propofol (weighted mean difference [WMD] = -55 minutes, 95% CI -93 to -17, p < 0.001), although heterogeneity was high (I² = 95.9%, τ² = 1,731.95, p < 0.001). No significant differences were observed for ICU (WMD = -4.26 hours, 95% CI: -17.07 to 8.55, I² = 89.9%, t² = 143.76, z = -0.65, p = 0.51) or hospital (WMD = -1.94 days, 95% CI: -4.17 to 0.30, I² = 65.1%, t² = 2.53) length of stay. Secondary outcomes (use of vasopressors and/or positive inotropes, postoperative atrial fibrillation, and nausea and/or vomiting) were inconsistently reported and showed no clear pattern.

Discussion: Volatile anesthetics reduce extubation time compared with propofol in adult cardiac surgery patients sedated in the ICU. However, evidence on secondary outcomes remains inconclusive due to limited and heterogeneous data.