Coronary Artery Bypass Grafting
Conditions
Keywords
Dexmedetomidine, Cardiac, Coronary Artery Bypass Grapht, Sedation, Propofol, Intravenous Anesthetics
Brief summary
Dexmedetomidine is a unique sedative anesthetic agent that allows accurate control of the depth of sedation and provides analgesia, cardio protection, renal protection, and neuroprotection without causing respiratory depression. It is an alpha 2-adrenoreceptor agonist that modulates the release of catecholamines from the central and autonomic nervous systems. When patients sedated by dexmedetomidine are allowed to become responsive, they are calm and cooperative (1). No other sedative agent has this feature, and sedated patients frequently awaken in a confused state. Investigators are conducting this study project to compare between dexmedetomidine based and propofol based anesthetic techniques with regard to hemodynamic changes, stress hormone release as well as cytokines in patients undergoing CPB for coronary revascularization.
Detailed description
100 patients undergoing elective CPB for coronary revascularization surgery. On the morning of operation the patients were randomized to receive one of two anesthetic techniques dependent on the type of sedation used. Standard anesthetic technique will be used for all patients except for using dexmedetomidine sedation in one group and propofol sedation in the other group.
Interventions
DRUGDexmedetomidine
Anesthesia will be maintained with continuous infusion of dexmedetomidine 0.5-0.7 µg/kg/h in addition to sevoflurane supplementation as required, to maintain arterial blood pressure and heart rate within 20% of preoperative values. Muscle relaxation will be maintained with continuous rocuronium infusion 0.6 mg/kg/h.
DRUGpropofol
Anesthesia will be maintained with continuous infusion of propofol 50-100 µg/kg/min in addition to sevoflurane supplementation as required, to maintain arterial blood pressure and heart rate within 20% of preoperative values. Muscle relaxation will be maintained with continuous rocuronium infusion 0.6 mg/kg/h.
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* patients scheduled for elective coronary revascularization surgery with cardiopulmonary bypass
Exclusion criteria
* Severely impaired left ventricular function (ejection fraction \<40%) * Valvular heart disease * Low cardiac output syndrome * Uncontrolled rapid atrial fibrillation * On plavix less than one week * Severe systemic non-cardiac disease * Infectious disease * Poorly controlled diabetes mellitus * patients on corticosteroids or other immunosuppressive treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| cardiac index | within intraoperative period | cardiac index measured in L/min/m2 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| pulmonary vascular resistance index | within intraoperative period | pulmonary vascular resistance index measured in dyn.sec/cm5/m2 |
| stroke volume index | within intraoperative period | stroke volume index measured in ml/m2/beat |
| left ventricular stroke work index | within intraoperative period | left ventricular stroke work index measured in gm/m2/beat |
| cardiac output | within intraoperative period | cardiac output measured in L/min |
| inotrope score | 1st 24 hours | appropriate score |
| duration of mechanical ventilation | 1st week | duration of mechanical ventilation measured in hours |
| systemic vascular resistance index | within intraoperative period | systemic vascular resistance index measured in dyn.sec/cm5/m2 |
| sedation score | 1st 24 hours | appropriate score |
| heart rate | within intraoperative period | heart rate measured in beat/min. |
| mean arterial blood pressure | within intraoperative period | mean arterial blood pressure measured in mm.Hg |
| central venous pressure | within intraoperative period | central venous pressure measured in mm.Hg |
| pulmonary capillary wedge pressure | within intraoperative period | pulmonary capillary wedge pressure measured in mm.Hg |
| mean pulmonary artery pressure | within intraoperative period | mean pulmonary artery pressure measure in mm.Hg |
Countries
Egypt
Outcome results
None listed