Comparison of the Effects of Ketamine-Dexmedetomidine and Sevoflurane-Sufentanil Anesthesia on Cardiac Biomarkers After Cardiac Surgery: An Observational Study

Říha, Hynek; Kotulák, Tomáš; Březina, Aleš; Hess, L.; Kramář, P; Szárszoi, Ondřej; Netuka, Ivan; Pirk, Jan

doi:10.33549/physiolres.932224

Cited by 28 publications

(6 citation statements)

References 30 publications

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“…Ji et al showed an improvement in mortality rate with iv dexmedetomidine infusion in patients undergoing CABG surgery (9). Riha et al found that the coadministration of dexmedetomidine-ketamine was associated with lower blood levels of cTnI and CKMB than sevofluranesufentanil anesthesia in patients undergoing elective CABG surgery (16).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery*

Türktan¹,

Güneş²,

Yaliniz³

et al. 2017

Turk J Med Sci

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IntroductionMyocardial protection is important in preventing the damaging effects of a cardiopulmonary bypass (CPB) on the myocardium, including ischemic and reperfusion injury (1). Eliminating or reducing myocardial injury can improve the clinical prognosis of patients undergoing cardiac surgery. Cardiac biomarkers are associated with the degree of cardiac injury and cardiac troponin I (cTnI), lactate, and creatine phosphokinase-MB (CKMB) are especially sensitive biomarkers for evaluating cardiac cell damage (2-4). Pyruvate, lactate, glucose, and insulin are respiratory substrates indicating heart perfusion. The level of pyruvate in the blood increases in the anaerobic state and pyruvate is converted to lactate under these conditions (3-5).Sevoflurane, a potent inhalation agent, decreases the inflammatory response and improves myocardial function after CPB (6). Dexmedetomidine, a selective and specific α-2 adrenoceptor agonist, has been frequently used as a sedative or adjuvant anesthetic drug in cardiac surgery. Dexmedetomidine has also been known to have some neuroprotective effects; however, data are insufficient for its cardioprotective effects in human studies. Remifentanil, a fast-acting opioid, has been generally used in cardiac surgery for cardiac protection before sternotomy (7).This study compared the cardiac effects of sevoflurane plus dexmedetomidine with those of sevoflurane plus remifentanil during adult cardiac surgery with CPB by examining levels of lactate, pyruvate, CKMB, and cTnI in patient blood samples. The hypothesis is that a difference Background/aim: Myocardial protection is an important factor of open heart surgery and biological biomarkers (lactate, CKMB, cardiac troponin I, and pyruvate) are used to assess myocardial damage. This study compares the effects of dexmedetomidine and remifentanil on myocardial protection during coronary artery bypass grafting (CABG) surgery. Materials and methods:Patients scheduled for elective CABG surgery (n = 60) were included in this study. Anesthesia induction was introduced with propofol, fentanyl, and vecuronium bromide. Anesthesia was maintained with remifentanil infusion and sevoflurane in the remifentanil group (Group R) and with dexmedetomidine infusion and sevoflurane in the dexmedetomidine group (Group D). Blood samples for biochemical markers were taken from the coronary sinus catheter before cardiopulmonary bypass (T1), 20 min after aortic cross-clamping (T2), 20 min after removal of the aortic cross-clamping (T3), and 10 min after separation from cardiopulmonary bypass (T4).Results: Demographic data were similar between the groups. Lactate level at the T2 period and CKMB levels during the study period were lower in Group D than in Group R. In both groups, all values except pyruvate significantly increased over time. Conclusion:The dexmedetomidine-sevoflurane combination may improve the cardioprotective effect in comparison with remifentanilsevoflurane in CABG surgery.

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Section: Discussionmentioning

confidence: 99%

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery*

Türktan¹,

Güneş²,

Yaliniz³

et al. 2017

Turk J Med Sci

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“…Four trials evaluated ketamine's effects on postoperative myocardial injury through either troponin levels or electrocardiogram criteria. [ 28 33 34 35 ] Two of these trials suggested that ketamine decreases myocardial injury after surgery.…”

Section: Brief Historymentioning

confidence: 99%

Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

2015

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Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

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“…8 Our study showed decreased levels of CKMB in DP group than the P group, albeit,not statistically significant, but it does indicate that the combination therapy is at least not harmful for the ischemic hearts. Riha et al 23 also reported decreased CKMB levels in cardiac surgery patients when they used DEX.…”

Section: Discussionmentioning

confidence: 95%

Does Concomitant Administration of Dexmedetomidine and Propofol Provide Myocardial Protection and Renal Function Preservation in Comparison to Propofol Alone; A Randomized Prospective Study

Rizvi¹,

Farooq²,

Hashmi³

et al. 2021

Pak Heart J

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Objective: To ascertain the safety and efficacy of concomitant administration of dexmedetomidine and propofol in maintaining myocardial protection and renal function integrity in comparison to propofol alone in adult cardiac surgical patients. Methodology: A randomized clinical trial was conducted at cardiac center Bahawalpur from June 2018 to January 2020. Study included 64 patients who underwent coronary artery bypass grafting (CABG). Two groups, DP (DEXMEDETOMIDINE (DEX) +Propofol) and P (Propofol alone) were made by allocating 32 patients in each group. Hemodynamic parameters (Heart rate, Diastolic blood pressure (DBP), systolic blood pressure (SBP) and mean arterial pressure (MAP) at different time intervals throughout the surgery were measured, pre and post-operative CKMB, any arrhythmias, events of tachycardia and bradycardia were recorded and renal parameters (urine output immediate post pump and 4 hours post pump, creatinine clearance of day 1 and day 2) were measured. Results: DP group showed stable hemodynamics with values of hemodynamic parameters were lesser and statistically significant than patients in group P (Heart rate (p<.05), DBP (P<.05), SBP (P<.05) and MAP (p<.05). Both groups showed insignificant difference in terms of incidence of arrhythmias (p=0.325), Post-operative CKMB (P=0.512), events of tachycardia (p=0.6) and bradycardia (p=0.5).Immediate post pump urine was statistically significant (p<.05), however, 4-hour post pump urine (p = 0.45), creatinine clearance of day 1 (p = 0.8) and day 2 (p =.092) were comparable. Conclusion: Concomitant administration of dexmedetomidine and propofol provide adequate cardioprotection by maintaining stable hemodynamics in comparison to propofol alone, however they did not prove to be effective renoprotective agents.

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Comparison of the Effects of Ketamine-Dexmedetomidine and Sevoflurane-Sufentanil Anesthesia on Cardiac Biomarkers After Cardiac Surgery: An Observational Study

Cited by 28 publications

References 30 publications

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery*

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery*

Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

Does Concomitant Administration of Dexmedetomidine and Propofol Provide Myocardial Protection and Renal Function Preservation in Comparison to Propofol Alone; A Randomized Prospective Study

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