Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial

Abstract

BackgroundArrhythmia occurring during and after surgery is one of the major complications in open-heart surgery. Dexmedetomidine is an intravenous alpha-2 agonist and very specific short-acting drug to protect the various organs against ischemic injuries and blood reflow. However, the effect of dexmedetomidine for preventing intraoperative heart arrhythmias has not been recognized.ObjectiveThis study aimed to determine the effect of dexmedetomidine on the incidence rate of heart arrhythmias and anesthetic required in off-pump coronary artery bypass surgery.MethodsThis randomized clinical trial was conducted on patients who were candidates for off-pump coronary artery bypass referring to Imam Reza Hospital of Mashhad, Iran, from July 2016 through January 2017. The patients were randomly assigned to two groups of intervention (infusion of 0.5 mcg/kg/h dexmedetomidine together with induction followed by infusion of 0.5 mcg/kg/h by the end of the surgery) or control (saline infusion). Mean arterial pressure (MAP) and heart rate (HR) were measured before induction, during surgery operation and ICU admission. Data were analyzed by SPSS version 18 using Chi Square and independent-samples t-test.ResultsA total of 76 patients with a mean age of 59.8 ± 8.2 years (in two groups of 38) were studied. The two groups had no statistically significant difference in terms of background variables. The MAP and HR values before induction, during surgery and ICU admission were significantly higher in the control group than in the intervention group (p=0.001). Out of the studied arrhythmias, the values of PAC (55.2% vs. 15.7%), PVC (81.5% vs. 21.0%), AF (26.3% vs. 7.8%), VTAC (21.0% vs. 2.6%) were significantly lower in dexmedetomidine group (p=0.001).ConclusionIt seems that dexmedetomidine administration during induction and surgery can cause significant reduction in most of the common arrhythmias in off-pump coronary bypass surgery. The use of dexmedetomidine maintains MAP and HR at significantly lower values, and changes compared to the control group as well as reduces the need for anesthetic compounds.Trial RegistrationThe present study has been registered at the Iranian Registry of Clinical Trials (www.IRCT.IR) with a code of IRCT2016072413159N9 before starting the study.FoundingThis study was fully sponsored by the Research Deputy at Mashhad University of Medical Sciences, Iran (grant number 941413).

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

“…17 However, our study found 8% incidence of arrhythmias. Administration of DEX is shown to reduce the arrhythmias in cardiac surgery patients by Liu et al 18 and Soltani et al 12 Our study did not found statistically different incidence of arrhythmias between both the groups .Shehabi et al 19 and Herr et al 20 also showed no correlation of administration of DEX and arrhythmias in cardiac surgery patients.…”

“…11 Soltani et al, also proved lesser heart rate and preservance of MAP in DEX group than the control. 12 Similarly PRODEX, largest clinical trial comparing DEX and propofol, found DEX non substandard to propofol in terms of incidence of hypotension and bradycardia in mechanically ventilated patients. 13 However SPICE III trial found more incidence of hypotension and bradycardia(although the incidence was merely 2.7% and 5.1% respectively) In critically ill patients receiving DEX in comparison to usual care group patients.…”

Influence of Dexmedetomidine on Post-operative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

“…All of the studies included patients that underwent open-heart cardiac surgery. Among them, ten RCTs included patients who underwent elective coronary artery bypass grafting (CABG) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), while the other five included patients who underwent mixed type of open-heart surgeries, including CABG, valvular surgeries, and aortic surgeries (10,16,(22)(23)(24).…”

“…The mean ages of the patients varied between 52 and 75 years, with proportions of male ranging from 32 to 90%. Mean body weight of the patients was reported in five studies (11,(13)(14)(15)22), while BMI was reported in another five studies (10,16,17,21,24). Dex was administered only during the procedure of surgery in two studies (13,23), only during the stay in Intensive Care Unit (ICU) in nine studies (10,12,(15)(16)(17)(19)(20)(21)(22), and during the surgery and ICU in four studies (11,14,18,24).…”

“…Pharmacologically, Dex is a highly selective α2-adrenoreceptor agonist which exerts various clinical efficacies during perioperative periods, such as sedation, analgesia, antianxiety, and diuresis (8,9). Besides, use of Dex is suggested to reduce POAF after cardiac surgeries in some previous randomized controlled trials (RCTs) (10)(11)(12), although other RCTs generally did not support a preventative efficacy of Dex for POAF (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). A few meta-analyses have been performed to evaluate the influence of Dex on POAF after cardiac surgery.…”