Dexmedetomidine as an anesthetic adjuvant in cardiac surgery: A cohort study

Abstract

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.

The effect of dexmedetomidine on renal function after surgery: A systematic review and meta‐analysis

“…Dexmedetomidine has been found to have other potential beneficial effects that have been associated with improved outcomes after surgery. 2 One of those beneficial effects is renal protection as there are now several randomized controlled trials in adults and children reporting a lower rate of kidney injury. [3][4][5] Several studies have compared the efficacy of dexmedetomidine at enhancing urine output and at decreasing the concentration of blood urea nitrogen and creatinine after surgery.…”

Dexmedetomidine Increases MMP-12 and MBP Concentrations after Coronary Artery Bypass Graft Surgery with Extracorporeal Circulation Anaesthesia without Impacting Cognitive Function: A Randomised Control Trial

“…In addition to blunting the haemodynamic response, dexmedetomidine use in cardiac surgery settings has been shown to exert antiarrhythmic effects [ 46 , 47 ], reduce post-surgical myocardial injury, and shorten the duration of mechanical ventilation and the ICU stay [ 48 , 49 ]. Dexmedetomidine also exerts neuroprotective effects, with studies reporting decreased neurological injury after cardiac surgery [ 33 ], lowered delirium incidents [ 35 , 45 ], and even reductions in the mortality rate [ 34 , 50 ]. Furthermore, a recent meta-analysis identified dexmedetomidine use as a protective factor for postoperative cognitive function after general anaesthesia in patients undergoing non-cardiac surgery [ 51 ].…”

“…The use of dexmedetomidine in cardiac surgery has been associated with several beneficial effects, including neuroprotection [ 33 , 34 , 35 , 36 ]. Dexmedetomidine is a selective alpha-2 adrenoreceptor agonist that induces sedation as well as anxiolytic and analgesic effects without causing respiratory suppression [ 36 , 37 ].…”

Nonopioid Analgesics in Postoperative Pain Management After Cardiac Surgery

“…DEX has also been shown to improve morbidity and mortality after cardiac surgery in 2 separate clinical trials. 45,46 In summary, DEX has been shown to decrease intraoperative and postoperative analgesic requirements; provide sedation, sympatholysis, and hemodynamic stability; and improve patient outcomes.…”