Arrhythmia, Blood Electrolyte Balance, Coronary Artery Bypass Graft, Dexmedetomidine, Lidocaine, Myocardial Injury, Unstable Angina
Conditions
Keywords
Coronary artery bypass graft, dexmedetomidine, lidocaine, myocardial injury, arrhythmia, blood electrolyte balance
Brief summary
The aim of the present study is to compare the antiarrhythmic and myocardial protective effect between lidocaine, dexmedetomidine, and their combined infusion in subjects undergoing coronary artery bypass graft.
Detailed description
Lidocaine has been reported to have an antiarrhythmic and myocardial protective effect. A previous study has reported that low-dose lidocaine infusion can decrease the incidence of ventricular fibrillation and tachycardia during the first 24 hours after coronary artery bypass graft (CABG). A recent study also reported that the lidocaine infusion during CABG could decrease the myocardial injury by measuring the CK-MB and Troponin-I blood level. Dexmedetomidine is an alpha-2 agonist and reduces the sympathetic tone and neuroendocrine stress response. Dexmedetomidine was reported to have a cardioprotective effect by a previous animal study. However, there was no clinical study evaluating the cardioprotective effect of dexmedetomidine. Therefore, we are trying to evaluate and compare the antiarrhythmic and myocardial protective effect between lidocaine, dexmedetomidine, and their combined infusion in subjects undergoing coronary artery bypass graft.
Interventions
DRUGLidocaine infusion
a bolus dose of Lidocaine 1.5 mg/kg after anesthetic induction with following infusion with 2 mg/kg/hr during the surgery and same dose during postoperative 24 hour in ICU.
DRUGDexmedetomidine infusion
Dexmedetomidine infusion during anesthetic induction with 0.2 mcg/kg/hr followed by 0.3 \ 0.7 mcg/kg/hr during the surgery
Sponsors
Samsung Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Those undergoing off-pump coronary artery bypass graft during the study period in Samsung Medical Center
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 * Patients with recent myocardial infarction * Those undergoing unplanned cardiopulmonary bypass during the surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Myocardial injury marker | postoperative ICU day 1 | Myocardial injury marker - CK-MB, and Troponin(i) blood level |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The blood sodium, potassium, calcium level | 1 day before surgery day, at the start of anesthetic induction, 2 hour, 4 hour after anesthetic induction, postoperative ICU day 1, 2, 3 | The blood sodium, potassium, calcium level |
| The incidence of arrhythmia during and after the surgery | 1 day before surgery day, at the start of anesthetic induction, 2 hour, 4 hour after anesthetic induction, postoperative ICU day 1, 2, 3 | The incidence of arrhythmia during and after the surgery: Ventricular premature beat,Atrial premature complex, Bigeminy, Trigeminy, Atrial fibrillation, Ventricular tachycardia, Ventricular fibrillation, Atrio-Ventricular block, PSVT, Junctional rhythm, External pacing |
| Postoperative ICU stay, Hospital stay, Extubation time | 1 day after hospital discharge | Postoperative ICU stay, Hospital stay |
| Inotropics use during and after the surgery | 1 day before surgery day, at the start of anesthetic induction, 2 hour, 4 hour after anesthetic induction, , postoperative ICU day 1, 2, 3 | Inotropics and other drug use during and after the surgery: Dopamine, NTG, dobutamine, milrinone, epinephrine, norepinephrine, amiodarone, diltiazem, remifentanil, esmolol, labetalol, nicardipine, Lasix, phenylephrine, lidocaine, sufentanil |
| The incidence of hypokalemia | 1 day before surgery day, at the start of anesthetic induction, 2 hour, 4 hour after anesthetic induction, , postoperative ICU day 1, 2, 3 | The incidence of hypokalemia |
Countries
South Korea
Outcome results
None listed