Use of Dexmedetomidine in Cardiac Surgery (CABG, Valve Replacement or Total Aortic Arch Replacement)
Conditions
Brief summary
It is important to establish a stable haemodynamics in patients undergoing cardiac surgery. Haemodynamic depression is common during induction of anaesthesia \[1\]. Sympathetic response due to tracheal intubation creates unwanted hypertensive responses on haemodynamics. Dexmedetomidine decreases stress responses and may provide a stable haemodynamics in situations such as surgery or induction of anaesthesia \[2-4\]. It may increase the tendency to hypotension and bradycardia by weakening the hyperdynamic response caused by sympathetic effect \[5,6\]. Concurrent use of dexmedetomidine may reduce anaesthetic opioid doses and provide more stable haemodynamics on systolic arterial pressure in patients undergoing CABG \[7\]. During cardiopulmonary bypass, dexmedetomidine may provide myocardial protection by exerting anti-inflammatory effects and may be beneficial for rapid recovery \[6,8,9\]. In cardiac surgery, dexmedetomidine provided bidirectional regulation of the anti-inflammatory response in which it showed antioxidant properties by inhibiting proinflammatory cytokine production and lipid peroxidation \[10,11\]. Dexmedetomidine in combination with propofol resulted in lower myocardial enzyme values than propofol alone \[12\]. The cardioprotective effects of propofol are dose-dependent; however, haemodynamic instability may be a concern at higher doses. In addition, dexmedetomidine may be considered a valid alternative to propofol, mainly because of its haemodynamic stability and possible myocardial protective effects \[13\]. It has been shown that dexmedetomidine pretreatment in valvular heart surgery can reduce the dose of propofol and the duration of mechanical ventilation and provide myocardial protection without an increase in adverse events \[14\]. Our study had two aims. The first was to provide a more stable haemodynamics by adding dexmedetomidine to induction in open cardiovascular surgery anaesthesia. Hypotension during induction and hypertensive response during tracheal intubation were tried to decrease. The second was to evaluate the effect of dexmedetomidine on cardiac enzymes only during induction, i.e. to evaluate its cardiac protective efficacy.
Interventions
DRUGPropofol group
In group P, 0.125 cc/kg saline infusion was administered in 10 minutes. Fentanyl was administered at a dose of 3 mcg/kg at 5 minutes of this application. Then propofol was administered until the eyelash reflex disappeared and the BIS value was 40. 0.6 mg/kg rocuronium was administered to facilitate intubation. All patients received 8 mg dexamethasone and lidocaine at a dose of 1 mg/kg.
DRUGDexmedetomidine
In group DP, dexmedetomidine at a dose of 0.5 mck/kg was administered over 10 minutes. At the 5th minute of this infusion, fentanyl was administered at a dose of 3 mcg/kg. Propofol was added until the BIS value was 40. The patients received 0.6 mg/kg rocuronium, 8 mg dexamethasone, and 1 mg/kg lidocaine.
Sponsors
Pamukkale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients over 18 years of age who underwent cardiovascular surgery (coronary artery bypass grafting, valve replacement or total aortic arch replacement) for ischaemic heart disease, valvular disease or aortic arch aneurysm were included.
Exclusion criteria
* Severe cardiovascular disease \[(NYHA class 4 or left ventricular ejection fraction (LVEF) less than 30%)\] , * Concomitant systemic disorders (e.g. patients with severe liver dysfunction or chronic renal failure on haemodialysis), * Pregnant women, * Emergency cases
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effect of dexmedetomidine on systolic blood pressure (SBP mm/hg) | SBP was recorded as the first basal value after monitoring of the patient. Data were recorded at 5 and 10 minutes after the start of induction and just before intubation. The highest value in the first 5 minutes after intubation was recorded. | Datawere (SBP mm/hg) recorded during induction, before intubation, after intubation and before the start of surgery. |
| Effect of dexmedetomidine on diastolic blood pressure (DBP mm/hg) | DBP was recorded as the first basal value after monitoring of the patient. Data were recorded at 5 and 10 minutes after the start of induction and just before intubation. The highest value in the first 5 minutes after intubation was recorded. | Datawere(DBP mm/hg) recorded during induction, before intubation, after intubation and before the start of surgery. |
| Effect of dexmedetomidine on heart rate (HR bpm) | HR was recorded as the first basal value after monitoring of the patient. Data were recorded at 5 and 10 minutes after the start of induction and just before intubation. The highest value in the first 5 minutes after intubation was recorded. | Datawere (HR bpm) recorded during induction, before intubation, after intubation and before the start of surgery. |
| Effect of dexmedetomidine on mean arterial pressure (MAP mm/hg) | MAP was recorded as the first basal value after monitoring of the patient. Data were recorded at 5 and 10 minutes after the start of induction and just before intubation. The highest value in the first 5 minutes after intubation was recorded. | Datawere (MAP mm/hg) recorded during induction, before intubation, after intubation and before the start of surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Creatin kinase MB (IU/L) level for cardiac protective effect | Creatin kinase MB was recorded 1 day before, 1 hour and 24 hours after surgery. | To evaluate the cardiac protective efficacy of dexmedetomidine, cardiac enzyme CKMB (IU/L) was recorded preoperatively, postoperative 1st hour and 24th hour. |
| Troponin I (ng/mL) level for cardiac protective effect | Troponin I was recorded 1 day before, 1 hour and 24 hours after surgery. | To evaluate the cardiac protective efficacy of dexmedetomidine, cardiac enzyme Troponin I (ng/mL) was recorded preoperatively, postoperative 1st hour and 24th hour. |
Countries
Turkey (Türkiye)
Outcome results
None listed