Objective: Dexmedetomidinehas been shownas an effective agent for management of postoperative sedation and analgesia on intensive care unit. The aim of the study was to assess dexmedetomidine for postoperative sedation in patients after Off Pump Coronary Artery Bypass (OPCAB) surgery. Design: Prospective, non-randomized, cohort study. Setting: Dept. of Anesthesiology and Intensive Care, Charles University, Faculty of Medicine, University Hospital Hradec Kralove, Czech Republic Material and methods: Study compares dexmedetomidine with standard analgesia protocol on cardiac surgical intensive care unit. Twenty patients after OPCAB were included in the study, 10 patients were given standard analgesia protocol with piritramid 15 mg I. M. q 12 hours (Group K), 10 patients were given dexmedetomidine (Group DEX) as loading infusion 1 µg/kg for 10 minutes followed by maintenance infusion 0,2–0,7 µg/kg/hr up to 24 hours. Additional analgesia, if required, was provided by morphine 5 mg I. V. Age, sex, ASA, NYHA, Ramsay score (RS), blood pressure (BP), heart rate (HR), respiratory rate (RR), haemoglobin saturation (SaO2), length of ventilatory support (VS), length of ICU stay (LOS), dose of dexmedetomidine and cost of analgesia and sedation were recorded. Statistical analysis was performed using SigmaStat Statistical Software, numerical data are presented as mean (range), *p<0.05. Results: No differences were found in RS, BP, HR, RR and SaO2 between the groups during first 24 hours. Patients from Group DEX required no additional analgesia, compared to 5 patients from Group K (p = 0.03). Mean length of VS was similar with the use of both protocols (432 minutes in Group DEX and 444 minutes in Group K), mean LOS was non-significantly shorter in Group DEX (22 hours, range 17–48) compared to Group K (38 hours, range 16–80). The mean loading dose of D was 77 µg (51–100), the mean total dose of dexmedetomidine was 409 µg (219–688). Two short-term discontinuations due to hypotension during dexmedetomidine sedation were recorded. Another patient in Group DEX developed coronary ischemia. The mean cost of sedation with dexmedetomidine was 1882 CZK (999–3130) and 32.5 CZK (15–20) for standard analgesia protocol. Conclusion: Dexmedetomidine was found as a useful agent for the provision of postoperative analgesia and sedation in OPCAB patients comparing to standard analgesia protocol.According to recent meta-analysis, alpha-2 adrenergic agonists reduce cardiovascular mortality and morbidity in high-risk postoperative patients. Large randomized trials are needed to define most cost-effectiveness target population for sedation with dexmedetomidine.

        Key words: postoperative – analgesia – sedation – cardiac surgery – OPCAB