Role of dexmedetomidine in myocardial protection during beating coronary artery bypass grafting.

  • Dr. Alpesh Sarvaia Senior Resident, Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat. India
  • Dr. Jigisha Pujara Associate Professor, Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat. India
  • Dr. Varsha Sarvaiya Professor, Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat. India
  • Dr Ms. Himani Pandya Research Associate Department of Research, U.N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat. India
  • Dr. Visharad Trivedi Assistant Professor, Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat. India
  • Dr. Sunil Kumar Ninama Assistant Professor, Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat. India
  • Dr Mr. Himanshu Acharya Research Fellow, Department of Research, U.N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat. India
Keywords: Myocardial, Ischemia, Arrhythmias

Abstract

Background: On-pump CABG is associated with a high risk of myocardial injuries and other complications that result into myocardial ischemia and arrhythmias. OPCAB surgery may reduce, although not entirely eliminate, these myocardial injuries. This prospective study was designed to determine whether the intraoperative use of Dexmedetomidine could reduce the incidence of myocardial injuries after off pump CABG.

Methods: A total of 100 patients who underwent off-pump coronary artery bypass surgery were included and randomly divided into Dexmedetomidine treated and Control groups (groups B and A, respectively) 50 patients in each groups. Following the first vascular anastomosis grafting, the patients in group B received a loading dose of 0.5 μg/kg/10min of Dexmedetomidine via central venous catheter followed by a continuous infusion of 0.5 μg/kg/hr of Dexmedetomidine. The infusion was discontinued at the end of surgery. In group A, 0.9% physiological saline was infused using identical methods to group B.

Results: The primary outcomes measured included serum levels of cardiac biomarkers like CPK-MB & Trop I. Secondary outcomes included hemodynamic stability, ischemia or arrhythmia events & post-operative ICU stay. Dexmedetomidine use significantly reduced postoperative CPK-MB (26.38 ± 7.11 v/s 30.48 ± 9.84, P=0.019) & Trop I (0.678 ± 0.742 v/s 1.011 ± 0.67, P=0.021) at 24 & 48 hours respectively. Intraoperative dexmedetomidine therapy also reduced the risk of overall complications.

Conclusion: Intra operative administration of low-dose dexmedetomidine reduces myocardial damage during off-pump coronary artery bypass grafting surgery as indicated by significantly decreased level of cardiac biochemical markers, CK-MB and cTnI post-operatively.

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References

Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA and Angelini GD: Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann ThoracSurg. 2000; 69 (4): 1198 1204 DOI: https://doi.org/10.1016/S0003-4975(00)01152-8.

Ketenci B, Enc Y, Ozay B, et al: Myocardial injury during off pump surgery. The effect of intraoperative risk factors. Saudi Med J. 2008; 29: 203 208.

Karu I, Tähepõld P, Sulling TA, Alver M, Zilmer M, Starkopf J. Off-pump coronary surgery causes immediate release of myocardial damage markers. Asian Cardiovasc Thorac Ann. 2009; 17(5):494-9. doi: https://doi.org/10.1177%2F0218492309348637.

Naseri E, Sevinc M, Erk MK: Comparison of off-pump and conventional coronary endarterectomy. Heart Surg Forum. 2003; 6(4):216-9.

Wei M, Jian K, Guo Z, et al: Effects of half dose aprotinin in off pump coronary artery bypass grafting. World J Surg. 2006 Jun; 30(6):1108-14.

Woo YJ, Grand TJ, Zentko S, et al: Creatine phosphate admin¬istration preserves myocardial function in a model of off pump coronary revascularization. J Cardiovasc Surg (Torino). 2005; Jun 46(3):297-305.

Tosun Z, Baktir M, Kahraman HC, et al: Does dexmedetomidine provide cardioprotection in coronary artery bypass grafting with cardiopulmonary bypass? A pilot study. J Cardiothorac Vasc Anesth. 2013 Aug; 27(4):710-5. doi: https://doi.org/10.1053/j.jvca.2012.12.013.

Sulaiman S, Karthekeyan RB, Vakamudi M, et al: The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting. Ann Card Anaesth. 2012; 15 (1):39-43.

Xiaohui Chi, Mingfeng Liao, Xin Chen, Yilin Zhao, Liu Yang, AilinLuo and Hui Yang, “Dexmedetomidine Attenuates Myocardial Injury in Off-Pump Coronary Artery Bypass Graft Surgery,” Journal of Cardio thoracic and Vascular Anesthesia. 2016; 30(1):44-50. DOI: https://doi.org/10.1053/j.jvca.2015.06.026.

Fellahi JL, Gué X, Richomme X, Monier E, Guillou L and Riou B: Short and long term prognostic value of postoperative cardiac troponin I concentration in patients undergoing coronary artery bypass grafting. Anesthesiology. 2003; Aug 99(2):270-4.

Lasocki S, Provenchère S, Bénessiano J, et al: Cardiac troponin I is an independent predictor of in hospital death after adult cardiac surgery. Anesthesiology. 2002; Aug 97(2):405-11.

Van Geene Y, van Swieten HA and Noyez L: Cardiac troponin I levels after cardiac surgery as predictor for in hospital mortality. Interact CardioVasc Thorac Surg. 2010; 10 (3): 413-416. DOI: https://doi.org/10.1510/icvts.2009.216408.

Paparella D, Cappabianca G, Malvindi P, et al: Myocardial injury after off pump coronary artery bypass grafting operation. Eur J CardiothoracSurg. 2007; 32: 481 487.

Tempe DK, Dutta D, Garg M, Minhas H, Tomar A and Virmani S: Myocardial protection with isoflurane during off pump coronary artery bypass grafting: a randomized trial. J CardiothoracVasc Anesth. 2011; 25: 59 65.

Vanden Eynden F, Cartier R, Marcheix B, Demers P and Bouchard D: Prognosis of perioperative myocardial infarction after off pump coronary artery bypass surgery. J Cardiovasc Surg (Torino). 2009; Aug 50(4):535-43.

Selvanayagam JB, Petersen SE, Francis JM, et al: Effects of off pump versus on pump coronary surgery on reversible and irreversible myocardial injury: a randomized trial using cardio¬vascular magnetic resonance imaging and biochemical markers. Circulation. 2004; 109: 345 350. doi: https://doi.org/10.1161/01.CIR.0000109489.71945.BD.

Gerlach AT and Dasta JF: Dexmedetomidine: an updated review. Ann Pharmacother. 2007; Feb; 41(2):245-52.

Dasta JF, Kane Gill SL and Durtschi AJ: Comparing dexmedeto¬midine prescribing patterns and safety in the naturalistic setting versus published data. Ann Pharmacother. 2004; Jul-Aug 38(7-8):1130-5.

Willigers HM, Prinzen FW and Roekaerts PM: Comparison of the effects of dexmedetomidine and esmolol on myocardial oxygen consumption in dogs. Eur J Anaesthesiol. 2004; Dec 21(12):957-66.

Snapir A, Posti J, Kentala E, et al: Effects of low and high plasma concentrations of dexmedetomidine on myocardial perfusion and cardiac function in healthy male subjects. Anesthesiology. 2006; 105(5):902-10. DOI: https://doi.org/10.1097/00000542-200611000-00010.

Kurita A and Shintani H: Risk factors for myocardial injury during off pump coronary artery bypass grafting. Heart Surg Forum. 2005; 8(6):E401-5.

Penttilä J, Helminen A, Anttila M, Hinkka S and Scheinin H: Cardiovascular and parasympathetic effects of dexmedetomidine in healthy subjects Can J Physiol Pharmacol. 2004; May 82(5):359-62.

Jalonen J, Hynynen M, Kuitunen A, et al: Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997; Feb 86(2):331-45.

Ren J, Zhang H, Huang L, Liu Y, Liu F, Dong Z. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery. Experimental and Therapeutic Medicine 2013;6(2):497-502. doi: https://dx.doi.org/10.3892%2Fetm.2013.1183.

Chen S, Hua F, Lu J, et al. Effect of dexmedetomidine on myocardial ischemia-reperfusion injury. International Journal of Clinical and Experimental Medicine. 2015; 8(11):21166-21172.

Role of dexmedetomidine in myocardial protection during beating coronary artery bypass grafting.
CITATION
DOI: 10.17511/ijmrr.2017.i02.13
Published: 2017-02-28
How to Cite
1.
Sarvaia A, Pujara J, Sarvaiya V, Pandya H, Trivedi V, Kumar Ninama S, Acharya H. Role of dexmedetomidine in myocardial protection during beating coronary artery bypass grafting. Int J Med Res Rev [Internet]. 2017Feb.28 [cited 2021Jun.18];5(2):176-87. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/821
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