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Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study
BACKGROUND: Myocardial protection in cardiac surgeries is a must and requires multimodal approaches in perioperative period to decrease and prevent the increase of myocardial oxygen demand and consumption that lead to postoperative cardiac complications including myocardial ischemia, dysfunction, an...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336971/ https://www.ncbi.nlm.nih.gov/pubmed/32275025 http://dx.doi.org/10.4103/aca.ACA_168_18 |
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author | Elgebaly, Ahmed Said Fathy, Sameh Mohamad Sallam, Ayman Ahmed Elbarbary, Yaser |
author_facet | Elgebaly, Ahmed Said Fathy, Sameh Mohamad Sallam, Ayman Ahmed Elbarbary, Yaser |
author_sort | Elgebaly, Ahmed Said |
collection | PubMed |
description | BACKGROUND: Myocardial protection in cardiac surgeries is a must and requires multimodal approaches in perioperative period to decrease and prevent the increase of myocardial oxygen demand and consumption that lead to postoperative cardiac complications including myocardial ischemia, dysfunction, and heart failure. STUDY DESIGN: Prospective, controlled, randomized, double-blinded study. AIMS: This study aims to study the effect of propofol-dexmedetomidine continuous infusion cardioprotection during open-heart surgery in adult patients. MATERIALS AND METHODS: Sixty adult patients of both sexes aged from 30 to 60 years old belonging to the American Society of Anesthesiologists III or IV undergoing open-heart surgery were randomly divided into two equal groups: Group P (control group) received continuous infusion of propofol at a rate of 2 mg/kg/h and 50 cc 0.9% sodium chloride solution infused at a rate of 0.4 μg/kg/h (used as a placebo) and Group PD received continuous infusion of propofol at a rate of 2 mg/kg/h and dexmedetomidine 200 μg diluted in 50 cc 0.9% sodium chloride solution infused at a rate of 0.4 μg/kg/h. Infusion for all patients started immediately preoperative till skin closure. Hemodynamic measurements of heart rate (HR), invasive mean arterial pressure, and oxygen saturation were recorded at baseline before induction of anesthesia, immediately after intubation, at skin incision, at sternotomy and every 15 min in the 1(st) h then every 30 min during the prebypass period then every 15 min in the 1(st) h then every 30 min after weaning from CPB till the end of the surgery. Serum biomarkers; cardiac troponin (cTnI) and creatine kinase-myocardial bound (CK-MB) samples were measured basally (T1), 15 min after unclamping of the aorta (T2), immediate postoperative (T3), and 24 h postoperative (T4). Intraoperative data were also recorded including the number of coronary grafts, aortic cross-clamping duration, duration of cardiopulmonary bypass (CPB), duration of surgery, and rhythm of reperfusion. Fentanyl requirement, extubation time, and length of intensive care unit (ICU) stay were also recorded for every case. RESULTS: There was no statistically significant differences as regard to demographic data between the studied two groups. HR and blood pressure recorded was lower in the PD group than the control group, and this difference was noted to be statistically significant. Furthermore, the PD group showed lower levels of myocardial enzymes (cTnI and CK-MB), decreased total fentanyl requirement, earlier postoperative extubation, and shorter ICU stay than the P (control) group. CONCLUSION: The use of propofol-dexmedetomidine in CPB surgeries offers more cardioprotective effects than the use of propofol alone. |
format | Online Article Text |
id | pubmed-7336971 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-73369712020-07-14 Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study Elgebaly, Ahmed Said Fathy, Sameh Mohamad Sallam, Ayman Ahmed Elbarbary, Yaser Ann Card Anaesth Original Article BACKGROUND: Myocardial protection in cardiac surgeries is a must and requires multimodal approaches in perioperative period to decrease and prevent the increase of myocardial oxygen demand and consumption that lead to postoperative cardiac complications including myocardial ischemia, dysfunction, and heart failure. STUDY DESIGN: Prospective, controlled, randomized, double-blinded study. AIMS: This study aims to study the effect of propofol-dexmedetomidine continuous infusion cardioprotection during open-heart surgery in adult patients. MATERIALS AND METHODS: Sixty adult patients of both sexes aged from 30 to 60 years old belonging to the American Society of Anesthesiologists III or IV undergoing open-heart surgery were randomly divided into two equal groups: Group P (control group) received continuous infusion of propofol at a rate of 2 mg/kg/h and 50 cc 0.9% sodium chloride solution infused at a rate of 0.4 μg/kg/h (used as a placebo) and Group PD received continuous infusion of propofol at a rate of 2 mg/kg/h and dexmedetomidine 200 μg diluted in 50 cc 0.9% sodium chloride solution infused at a rate of 0.4 μg/kg/h. Infusion for all patients started immediately preoperative till skin closure. Hemodynamic measurements of heart rate (HR), invasive mean arterial pressure, and oxygen saturation were recorded at baseline before induction of anesthesia, immediately after intubation, at skin incision, at sternotomy and every 15 min in the 1(st) h then every 30 min during the prebypass period then every 15 min in the 1(st) h then every 30 min after weaning from CPB till the end of the surgery. Serum biomarkers; cardiac troponin (cTnI) and creatine kinase-myocardial bound (CK-MB) samples were measured basally (T1), 15 min after unclamping of the aorta (T2), immediate postoperative (T3), and 24 h postoperative (T4). Intraoperative data were also recorded including the number of coronary grafts, aortic cross-clamping duration, duration of cardiopulmonary bypass (CPB), duration of surgery, and rhythm of reperfusion. Fentanyl requirement, extubation time, and length of intensive care unit (ICU) stay were also recorded for every case. RESULTS: There was no statistically significant differences as regard to demographic data between the studied two groups. HR and blood pressure recorded was lower in the PD group than the control group, and this difference was noted to be statistically significant. Furthermore, the PD group showed lower levels of myocardial enzymes (cTnI and CK-MB), decreased total fentanyl requirement, earlier postoperative extubation, and shorter ICU stay than the P (control) group. CONCLUSION: The use of propofol-dexmedetomidine in CPB surgeries offers more cardioprotective effects than the use of propofol alone. Wolters Kluwer - Medknow 2020 2020-04-07 /pmc/articles/PMC7336971/ /pubmed/32275025 http://dx.doi.org/10.4103/aca.ACA_168_18 Text en Copyright: © 2020 Annals of Cardiac Anaesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Elgebaly, Ahmed Said Fathy, Sameh Mohamad Sallam, Ayman Ahmed Elbarbary, Yaser Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study |
title | Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study |
title_full | Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study |
title_fullStr | Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study |
title_full_unstemmed | Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study |
title_short | Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study |
title_sort | cardioprotective effects of propofol-dexmedetomidine in open-heart surgery: a prospective double-blind study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336971/ https://www.ncbi.nlm.nih.gov/pubmed/32275025 http://dx.doi.org/10.4103/aca.ACA_168_18 |
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