Coronary Artery Bypass Graft, Hypokalemia, Cardiac Arrhythmia, Dexmedetomidine, Remifentanil
Conditions
Keywords
coronary artery bypass graft, hypokalemia, cardiac arrhythmia, dexmedetomidine, remifentanil
Brief summary
We are trying to investigate whether intraoperative dexmedetomidine infusion could decrease the incidence of intraoperative hypokalemia and arrhythmia, and myocardial injury in patients undergoing off-pump coronary artery bypass graft, and trying compare these effects with those of remifentanil infusion.
Detailed description
Alpha2-adrenergic agonist, dexmedetomidine, is recently used for sedation, analgesia or adjuvant to general anesthesia. Postsynaptic activation of alpha2 adrenoceptors in the central nervous system (CNS) inhibits sympathetic activity and thus can decrease blood pressure and heart rate. The blockade of sympathetic activity decrease the neuroendocrine stress response and may decrease the incidence of hypokalemia. The hypokalemia can increase the incidence of arrythmia, especially in cardiac patients. We postulated that dexmedetomidine could decrease the neuroendocrine stress response, thus decrease arrhythmia during cardiac surgery. Furthermore, dexmedetomidine have been reported to have cardioprotective effect with previous animal studies. Therefore, the aim of the present study is to investigate whether the intraoperative dexmedetomidine infusion can reduce the incidence of hypokalemia and arrythmia, and myocardial injury in subjects undergoing off-pump coronary artery bypass graft. We are also trying to compare these effects with those of remifentanil infusion.
Interventions
DRUGDexmedetomidine infusion
Dexmedetomidine infusion 0.2 mcg/kg/hr during anesthetic induction 0.3 - 0.7 mcg/kg/hr during the surgery
Remifentanil infusion 0.05 - 0.3 mcg/kg/min during the anesthetic induction and surgery
Sponsors
Samsung Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
20 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Those undergoing off-pump coronary artery bypass graft during March, 2012 \ February, 2013 in Samsung Medical Center * Age between 20 and 70 yrs old
Exclusion criteria
* Any patients with plasma aldosterone, or glucocorticoid disorder including primary hyperaldosteronism, renovascular hypertension, rennin-secreting tumor, salt-wasting renal disease, Cushing syndrome * Patients with recent exogenous steroid administration or previous diuretics therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| serum potassium concentration | at 24 hour before anesthetic induction | serum potassium concentration at the day before anesthetic induction |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| incidence of hypokalemia | 24 hour, 1 min before anesthetic induction, 20 min, 2 and 3 hour after the start of anesthetic induction | incidence of hypokalemia (serum K \< 3.5) incidence of hypokalemia (serum K \< 4.5) |
| hemodynamic parameters | 24 hour, 1 min before anesthetic induction, 20 min, 2 and 3 hour after the start of anesthetic induction | hemodynamic parameters (blood pressure, heart rate, central venous pressure, cardiac output, SvO2) |
| arterial blood gas analysis results | 24 hour, 1 min before anesthetic induction, 20 min, 2 and 3 hour after the start of anesthetic induction | arterial blood gas analysis results |
| Myocardial injury marker | 2, 24, 48 hour after the end of surgery | serum concentration of CK-MB, Troponin (i)as a marker for myocaridial injury |
| Left ventricular function | 72 hour before, during (immediate after grafting), 72 hour after surgery | left ventricular function determined by Tei index, ejection fraction of preoperative, intraoperative, postoperative echocardiography |
| inotropics, vasopressor requirement | 24 hour, 1 min before anesthetic induction, 20 min, 2 and 3 hour after the start of anesthetic induction | inotropics, vasopressor requirement |
Countries
South Korea
Outcome results
None listed