PERIOPERATIVE DEXMEDETOMIDINE INFUSION FOR CARDIAC AND RENAL PROTECTION IN CARDIAC SURGERIES
Main Article Content
Keywords
Dexmedetomidine, cardiac and renal protection, cardiac surgery.
Abstract
INTRODUCTION: Cardiac surgeries performed under cardiopulmonary bypass (CPB) are not devoid of adverse effects related to cardiac and renal injuries. Dexmedetomidine, an alpha-2-agonist, is shown to have protective role.
MATERIAL AND METHODS
AIM: To study the role of perioperative dexmedetomidine infusion on cardiac and renal protection during valvular heart surgeries.
This prospective, interventional and randomised study included 50 adult patients scheduled for elective valvular heart surgeries under CPB. The patients were randomised into 2 groups (1 and 2). Group 1 received dexmedetomidine at initiation of CPB at 0.5 mcg/kg bolus over 10 minutes followed by infusion at 0.25 mcg/kg/hr till extubation. Group 2 received standard cardiac anaesthesia care protocol. Cardiac enzymes (CPK-MB, LDH), renal parameters (Blood urea, serum creatinine, creatinine clearance, total urine output) , serum electrolytes (Na/K) ,serum lactate, time to extubation, Ramsay sedation score (RSS) ( till 4 hours post-extubation) were compared over a span of 72 hours.
RESULTS: The observations and results of our study revealed that dexmedetomidine imparted cardiac and renoprotective properties as evidenced by significantly lower levels of CPK-MB, LDH, Serum lactate, Blood urea, serum creatinine, serum sodium in Group 1 as compared to Group 2 at all the times on both post-op days (p<0.05). Time to extubation and RSS were also significantly less in Group 1.
CONCLUSION: Dexmedetomidine offers cardiac and renoprotective, analgesic sparing, and anxiolytic effects, hence should be used in cardiac surgeries.
References
2. Daly RC, Dearani JA, McGregor C, Mullany C, Orszulak TA, Puga FJ, et al. Fifty years of open heart surgery at the Mayo clinic. Mayo clin Proc. 2005:80(5):630-40.
3. Henke K, Eigsti J. Bypass injury: implications of cardiopulmonary bypass. Dimens Crit Care Nurs.2003;22(2);64-70.
4. Kemp KM, Henderlight L, Neville M. Precedex: Is it the future of cooperative sedation? Nursing.2008:38:7-8.
5. Ammar AS, Mahumoud KM, Kasmy ZA, Helwa MA. Cardiac and renal protective effects of dexmedetomidine in cardiac surgeries: A randomised control trial. Saudi J Anaesth.2016;10:395-401.
6. Zhang Y, Yi D, Xiao G, Wang W, Lin W, Zeng H, et al. Myocardial protection effects of dexmedetomidine priming on cardiopulmonary bypass surgery for children with congenital heart disease. Int J Clin Exp Med.2018;11(2):975-81.
7. Chi X, Liao M, Chen X, Zhao Y, Yang L, Luo A, et al. Dexmedetomidine attenuates myocardial injury in off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anaesth. 2016;30:44-50.
8. Munoz R, Lausssen PC, Palacio G, Zeinko L, Piercey G, Wessel DL. Changes in whole blood lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: an early indicator of morbidity and mortality. J Thorac Cardiovasc Surg 2000;119(1):155-62.
9. Biccard BM, Goga S, de Beurs J. Dexmedetomidine and cardiac protection for noncardiac surgery: A meta-analysis of randomised controlled trials. Anaesthesia. 2008;63(1):4-14.
10. Abd Aziz N, Chuee MC, Yong CY, Hassan Y, Awaisu A, Hassan J, et al. Efficacy and safety of dexmedetomidine versus morphine in post-operative cardiac surgery patients. Int J Clin Pharm. 2011;33:150-4.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Mansha Madan
Senior Resident, Department of Anaesthesia and Intensive care, VMMC and Safdarjung Hospital, New Delhi -110029
Dr. Meenakshi Kumar
Professor, Department of Anaesthesia and Intensive care, VMMC and Safdarjung Hospital, New Delhi -110029
Dr. Sushil Guria
Associate Professor, Department of Anaesthesia and Intensive care, VMMC and Safdarjung Hospital, New Delhi -110029
Dr. Aadhar Khutell
Senior Resident, Department of Anaesthesia and Intensive care, VMMC and Safdarjung Hospital, New Delhi -110029
Dr. Simarjot Singh Sodhi
MS Orthopaedics, DNB Orthopaedics, Central Institute Of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi-110029