Protective effect of dexmedetomidine in coronary artery bypass grafting surgery

Abstract

The aim of this study was to observe the impact of dexmedetomidine on postoperative myocardial injury in patients undergoing off-pump coronary artery bypass (OPCAB) grafting. One hundred and sixty-two patients who were undergoing OPCAB surgery were randomly divided into control and dexmedetomidine groups (groups C and Dex, respectively). Following the first vascular anastomosis grafting, the patients in group Dex received a continuous intravenous infusion of 0.2–0.5 μg/kg/h dexmedetomidine, until they were transferred to the Cardiac Surgery intensive care unit (ICU) for 12 h. Patients in group C received physiological saline intraoperatively and an intravenous infusion of 2–4 mg/kg/h isopropylphenol for postoperative sedation. Invasive arterial pressure and heart rate were continuously monitored for 5 min subsequent to entry into the operating theatre (T0), immediately following surgery (T1), 12 h post-surgery (T2), 24 h post-surgery(T3), 48 h post-surgery(T4) and 72 h post-surgery (T5). Blood samples were taken to determine the plasma levels of cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) at each time point. At 72 h post-surgery, a dynamic electrocardiogram was monitored. The blood pressure, heart rate, levels of cTnI, CK-MB, norepinephrine and cortisol, and postoperative arrhythmic events in the patients in group Dex all decreased compared with those in group C. The duration of mechanical ventilation and ICU residence time were also shorter than those in the control group (P<0.05). Dexmedetomidine reduced post-surgical myocardial injury in patients who had undergone OPCAB surgery.

Effect of Selenium on Ischemia-Reperfusion Injury in the Coronary Artery Bypass Graft Surgery: A Clinical Trial Study

“…Depletion of Se state during the surgery triggers neutrophil accumulation in reperfused sites, which is the primary source of ROS and proteolytic enzyme generation (39). Crucially, the myocardial injury has been measured by serum cardiac enzymes (5,40). Although the value of cardiac biomarkers for adverse outcome following CABG is poorly understood, it is suggested that among myocardial necrosis markers, cardiac troponins are the gold standard for detection of the cardiac damage (9, 32) Multiple Tn isoforms have been detected in muscles, but CTnT and CTnI are known as cardiac specific isoforms.…”

“…However, myocardial reperfusion itself causes tissue damage, which is known as an ischemic/reperfusion (I/R) injury (1)(2)(3)(4)(5). Accumulating evidence suggests that generation of reactive oxygen species (ROS) following neutrophil activation and inflammatory reactions is the main triggering factor of the I/R injury.…”

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

“…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)(4)(5).…”

“…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)(3)(4). Pyruvate, lactate, glucose, and insulin are respiratory substrates indicating heart perfusion.…”

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).…”