OBJECTIVE:α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surgery.METHODS:We performed a retrospective analysis of prospectively collected data from all adult patients (> 18 years old) undergoing cardiac surgery. Patients were divided into two groups, regarding the use of dexmedetomidine as an adjuvant intraoperatively (DEX group) and a control group who did not receive α-2-agonist (CON group).RESULTS:A total of 1302 patients who underwent cardiac surgery, either coronary artery bypass graft or valve surgery, were included; 796 in the DEX group and 506 in the CON group. Need for reoperation (2% vs. 2.8%, P=0.001), type 1 neurological injury (2% vs. 4.7%, P=0.005) and prolonged hospitalization (3.1% vs. 7.3%, P=0.001) were significantly less frequent in the DEX group than in the CON group. Thirty-day mortality rates were 3.4% in the DEX group and 9.7% in the CON group (P<0.001). Using multivariable Cox regression analysis with in hospital death as the dependent variable, dexmedetomidine was independently associated with a lower risk of 30-day mortality (odds ratio [OR]=0.39, 95% confidence interval [CI]: 0.24-0.65, P≤0.001). The Logistic EuroSCORE (OR=1.05, 95% CI: 1.02-1.10, P=0.004) and age (OR=1.03, 95% CI: 1.01-1.06, P=0.003) were independently associated with a higher risk of 30-day mortality.CONCLUSION:Dexmedetomidine used as an anesthetic adjuvant was associated with better outcomes in patients undergoing coronary artery bypass graft and valve surgery. Randomized prospective controlled trials are warranted to confirm our results.
A pressão expiratória final de dióxido de carbono (PETCO2) está disponível nas salas de operações, como tecnologia anestésica, relacionando-se com metabolismo, ventilação e circulação. Quando os dois primeiros parâmetros estão controlados, a PETCO2 reflete o fluxo pulmonar, portanto o débito cardíaco (DC). A PETCO2 menor que 20 mmHg está associada com baixo DC (< 2L/min), mesmo que outros parâmetros hemodinâmicos estejam adequados. A propósito, aumentos posteriores da pré-carga, redução da pós-carga, estabelecimento de adequado sincronismo atrioventricular ou aumento no inotropismo são necessários para elevar a PETCO2 acima de 25 mmHg. A literatura descreve o uso de PETCO2 como avaliação adequada da ressuscitação cardiopulmonar depois de parada cardíaca, sendo método alternativo à termodiluição na avaliação do DC. Pouco tem sido relatado sobre o seu uso na cirurgia cardíaca. O objetivo do presente trabalhado foi avaliar o momento adequado para o "desmame" da circulação extracorpórea (CEC), considerando a PETCO2 como parâmetro de avaliação do DC. No período de junho de 1996 a junho de 1997, 200 pacientes foram submetidos a cirurgia cardíaca com CEC, com avaliação da medida da PETCO2 na saída da CEC. A PETCO2 em torno de 27 mmHg foi indicativa de um bom DC, o suficiente para o desmame da CEC, desde que outros parâmetros hemodinâmicos e metabólicos estivessem adequados. Nenhum paciente retornou à CEC por falha cardiopulmonar, podendo ser utilizado como método confiável para o "desmame" da CEC.
Capnography has been recommended as an anesthetic technique and the end-tidal carbon dioxide tension (PETCO2) is available in the operating room. PETCO2 is governed by metabolism, ventilation and circulation. When the first two parameters are controlled, PETCO2 reflects the lung flow, therefore the cardiac output. Studies have shown that PETCO2 lower than 20 mmHg is invariably associated with a cardiac output less than 2 L/min, even if other hemodynamic parameters are appropriate. Further increases in the preload, reduction of the afterload, establishment of an appropriate atrioventricular synchrony or increasing inotropy is necessary to increase PETCO2 above 25 mmHg. A considerable body of literature describes the use of PETCO2 to assess the adequacy of cardiopulmonary resuscitation after cardiac arrest. Besides, attempts have been made to use PETCO2 as an alternative to the thermodilution technique for determining cardiac output. Little has been reported of its use in cardiac surgery. From June 1996 to June 1997 we have studied 200 patients, submitted to CPB suggesting that PETCO2 around 27 mmHg would indicate a cardiac output good enough to wean the patients on the cardiopulmonary circulation so long as other hemodynamic and metabolic parameters were adequate. None of the patients required CPB giving us the impression that end-tidal carbon dioxide tension generally indicates an appropriate cardiac output
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