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Hemodynamic Effects of Dexmedetomidine in Patients undergoing Off Pump Coronary Artery Bypass Grafting Surgery (OPCAB): A Placebo Controlled Prospective Randomized Double Blind Study

Prasad S.R., Associate Professor, Department of Cardiac Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru, Karnataka 560069, India. , Manjunath V.1 , Prasad S.R.2 , Pranav J. Adoni3

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Indian Journal of Anesthesia and Analgesia 5(5):p 787-792, May 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5518.15

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Abstract

 

Aims & Objectives: To study the effect of Dexmedetomidine on hemodynamic parameters in cases of OPCAB during 

• Intubation,
• Intraoperatively during grafting and
• Postoperatively till extubation.
Methods: A prospective randomized double blind study involving 60 patients of either sex undergoing elective OPCAB was conducted; patients were randomly divided into two groups of 30 each. Patients received either Dexmedetomidine as loading dose of 1µg/kg over 10 min followed by a maintenance dose of 0.5µg/kg/hr (group A) or a placebo infusion of normal saline (Group B). The hemodynamic response during intubation, intraoperative hemodynamic variations, the heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded before extubation, during extubation, at 1, 3 minutes and every 5 minutes thereafter. Extubation quality was assessed on a 5 point scale and sedation by Richmond Agitation–  Sedation Scale. 

Results: In Dexmedetomidine group (group A) heart rate, BIS value was on the lower side compared to the placebo group (group B). The increase in heart rate in group A was significant only at 1 min after intubation whereas in group B it extended during 3rd & 5th min after intubation. The intraoperative variations in heart rate, mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP) were minimal in group A as compared to group B. There was significant increase in heart rate and mean arterial pressure (p<0.001) during extubation in group B. Ninety percent of patients in group A and 16.7% in group B could be extubated smoothly. The average time to extubate was 292.50±45.3 min and 255±56min minutes in groups A, and B respectively (P value 0.13). 

Conclusion: Dexmedetomidine is a good adjuvant to general anaesthesia, reduces the stress response to intubation and provides minimal variations in hemodynamic intraoperatively. Dexmedetomidine continued postoperatively provides adequate sedation and reduces the stress response to extubation without prolonging the time to extubation.



 

 

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5518.15

Keywords

Coronary Artery Bypass Grafting; Dexmedetomidine; Extubation; Hemodynamic; Intubation.

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