Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery

Abstract

Background Cardiac surgery is associated with a high risk of cardiovascular and other complications that translate into increased mortality and healthcare costs. This retrospective study was designed to determine whether the perioperative use of dexmedetomidine could reduce the incidence of complications and mortality following cardiac surgery. Methods and Results 1,134 patients who underwent CABG and CABG plus valvular and/or other procedures were included. 568 received intravenous dexmedetomidine infusion and 566 did not. Data were adjusted with propensity scores and multivariate logistic regression was used. The primary outcomes measured included mortality and postoperative major adverse cardiocerebral events (MACE: stroke, coma, perioperative myocardial infarction, heart block or cardiac arrest). Secondary outcomes included renal failure, sepsis, delirium, postoperative ventilation hours, length of hospital stay and 30-day readmission. Dexmedetomidine use significantly reduced postoperative in-hospital [1.23% vs. 4.59%; adjusted odds ratio (OR), 0.34; 95% confidence intervals (CI), 0.192 to 0.614; P < 0.0001], 30-day (1.76% vs. 5.12%; adjusted OR, 0.39; 95% CI, 0.226 to 0.655; P <0.0001) and 1-year (3.17% vs. 7.95%; adjusted OR, 0.47; 95% CI, 0.312 to 0.701; P = 0.0002) mortalities. Perioperative dexmedetomidine therapy also reduced the risk of overall complications (47.18 vs. 54.06%; adjusted OR, 0.80, 95% CI, 0.68 to 0.96; p= 0.0136) and delirium (5.46% vs. 7.42%; adjusted OR, 0.53; 95% CI, 0.37 to 0.75; p=0.0030). Conclusions Perioperative dexmedetomidine use was associated with a decrease in postoperative mortality up to one year and decreased incidence of postoperative complications and delirium in patients undergoing cardiac surgery.

The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients

“…This was a subanalysis using the data the authors used before 12 to investigate the effect of Dex on outcomes for the elderly cardiac surgery population. The current study found that perioperative Dex use significantly reduced in-hospital and NOTE.…”

“…[8][9][10][11] It was associated with decreased mortality, time to extubation, and hospital length of stay (LOS) in cardiac surgical patients. [12][13][14][15] The authors previously have published a study describing the effects of Dex on outcomes of patients undergoing cardiac surgery. 12 In that study, Dex reduced in-hospital, 30-day, and 1-year mortality and decreased the incidences of postoperative complications and delirium.…”

“…[12][13][14][15] The authors previously have published a study describing the effects of Dex on outcomes of patients undergoing cardiac surgery. 12 In that study, Dex reduced in-hospital, 30-day, and 1-year mortality and decreased the incidences of postoperative complications and delirium. Portions of these data also were used in the study published in the Journal of Cardiothoracic and Vascular Anesthesia, which found that Dex infusion during coronary artery bypass graft (CABG) surgery was more likely to achieve improved in-hospital, 30-day, and 1-year survival rates, and a significantly lower incidence of delirium.…”

Procedural sedation with dexmedetomidine for ultrasound guided central venous cannulation in agitated, high risk critically ill patients. A series of three cases

“…5,6 It has also been safely used in patients with known cardiac disease. 10 It is devoid of significant respiratory depressant effect, but is associated with bradycardia when used at higher dose (maintenance dose of more than 0.7 μg/kg/hr). 6 Elderly patients are more susceptible to hypotension.…”

Effect of dexmedetomidine infusion on N-terminal pro-B-type natriuretic peptide level in patients with femoral shaft fractures under general anesthesia

“…Perianesthetic use of dexmedetomidine has a hemodynamic stability effect, which is associated with a decrease in postoperative mortality and reduction in the incidence of postoperative complications (Ji et al, 2013;Shin et al, 2013). The protective effects of dexmedetomidine on postoperative myocardial injury have been defined (Ren et al, 2013).…”