Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery

A randomized clinical trial

Authors

  • Shima Sheybani M.D, Anesthesiologist, Fellowship of Cardiac Anesthesiology, Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Keywords:

Coronary Bypass, Dexmedetomidine, Mean Arterial Pressure, Heart rate, Arrhythmia

Abstract

Background: Arrhythmia occurring during and after surgery is one of the major complications in open-heart surgery. Dexmedetomidine is an intravenous alpha-2 agonist and very specific short-acting drug to protect the various organs against ischemic injuries and blood reflow. However, the effect of dexmedetomidine for preventing intraoperative heart arrhythmias has not been recognized. 

Objective: This study aimed to determine the effect of dexmedetomidine on the incidence rate of heart arrhythmias and anesthetic required in off-pump coronary artery bypass surgery.

Methods: This randomized clinical trial was conducted on patients who were candidates for off-pump coronary artery bypass referring to Imam Reza Hospital of Mashhad, Iran, from July 2016 through January 2017. The patients were randomly assigned to two groups of intervention (infusion of 0.5 mcg/kg/h dexmedetomidine together with induction followed by infusion of 0.5 mcg/kg/h by the end of the surgery) or control (saline infusion). Mean arterial pressure (MAP) and heart rate (HR) were measured before induction, during surgery operation and ICU admission. Data were analyzed by SPSS version 18 using Chi Square and independent-samples t-test.

Results: A total of 76 patients with a mean age of 59.8 ± 8.2 years (in two groups of 38) were studied. The two groups had no statistically significant difference in terms of background variables. The MAP and HR values before induction, during surgery and ICU admission were significantly higher in the control group than in the intervention group (p=0.001). Out of the studied arrhythmias, the values of PAC (55.2% vs. 15.7%), PVC (81.5% vs. 21.0%), AF (26.3% vs. 7.8%), VTAC (21.0% vs. 2.6%) were significantly lower in dexmedetomidine group (p=0.001). 

Conclusion: It seems that dexmedetomidine administration during induction and surgery can cause significant reduction in most of the common arrhythmias in off-pump coronary bypass surgery. The use of dexmedetomidine maintains MAP and HR at significantly lower values, and changes compared to the control group as well as reduces the need for anesthetic compounds.

Trial Registration: The present study has been registered at the Iranian Registry of Clinical Trials (www.IRCT.IR) with a code of IRCT2016072413159N9 before starting the study.

Founding: This study was fully sponsored by the Research Deputy at Mashhad University of Medical Sciences, Iran (grant number 941413).

 

References

Chrysostomou C, Beerman L, Shiderly D, Berry D, Morell VO, Munoz R. Dexmedetomidine: a novel drug

for the treatment of atrial and junctional tachyarrhythmias during the perioperative period for congenital

cardiac surgery: a preliminary study. Anesth Analg. 2008; 107(5): 1514-22. doi:

1213/ane.0b013e318186499c. PMID: 18931208.

Wunsch H, Kahn JM, Kramer AA, Wagener G, Li G, Sladen RN, et al. Dexmedetomidine in the Care of

Critically Ill Patients from 2001 to 2007: An Observational Cohort Study. Anesthesiology. 2010; 113(2):

-94. doi: 10.1097/ALN.0b013e3181e74116. PMID: 20613466.

Ji F, Li Z, Nguyen H, Young N, Shi P, Fleming N, et al. Perioperative dexmedetomidine improves

outcomes of cardiac surgery. J Cardiothorac Vasc Anesth. 2014; 28(2): 267-73. doi:

1053/j.jvca.2013.06.022. PMID: 24182835, PMCID: PMC4402998.

Liu X, Zhang K, Wang W, Xie G, Fang X. Dexmedetomidine sedation reduces atrial fibrillation after

cardiac surgery compared to propofol: a randomized controlled trial. Critical Care. 2016; 20(1): 298. doi:

1186/s13054-016-1480-5. PMID: 27654700, PMCID: PMC5031329.

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:

3892/etm.2013.1183. PMID: 24137215, PMCID: PMC3786847.

Narisawa A, Nakane M, Kano T, Momose N, Onodera Y, Akimoto R, et al. Dexmedetomidine sedation

during the nighttime reduced the incidence of postoperative atrial fibrillation in cardiovascular surgery

patients after tracheal extubation. J Intensive Care. 2015; 3(1): 26. doi: 10.1186/s40560-015-0092-5.

PMID: 26060574, PMCID: PMC4460695.

Shehabi Y, Grant P, Wolfenden H, Hammond N, Bass F, Campbell M, et al. Prevalence of delirium with

dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled

trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology. 2009; 111(5): 1075- 84. doi: 10.1097/ALN.0b013e3181b6a783. PMID: 19786862.

Balkanay OO, Goksedef D, Omeroglu SN, Ipek G. The dose-related effects of Dexmedetomidine on renal

functions and serum neutrophil gelatinase-associated lipocalin values after coronary artery bypass grafting:

a randomized, triple-blind, placebo-controlled study. Interact Cardiovasc Thorac Surg. 2015; 20(2): 209-14.

doi: 10.1093/icvts/ivu367. PMID: 25392341.

Herr DL, Sum-Ping SJ, England M. ICU sedation after coronary artery bypass graft surgery:

dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth. 2003;

(5): 576-84. doi: 10.1016/S1053-0770(03)00200-3.

Karaman Y, Abud B, Tekgul ZT, Cakmak M, Yildiz M, Gonullu M. Effects of dexmedetomidine and

propofol on sedation in patients after coronary artery bypass graft surgery in a fast-track recovery room

setting. J Anesth. 2015; 29(4): 522-8. doi: 10.1007/s00540-015-1975-2. PMID: 25617159.

Park JB, Bang SH, Chee HK, Kim JS, Am Lee S, Shin JK. Efficacy and safety of dexmedetomidine for

postoperative delirium in adult cardiac surgery on cardiopulmonary bypass. Korean J Thorac Cardiovasc

Surg. 2014; 47(3): 249-54. doi: 10.5090/kjtcs.2014.47.3.249. PMID: 25207222, PMCID: PMC4157475.

Geng J, Qian J, Cheng H, Ji F, Liu H. The influence of perioperative dexmedetomidine on patients

undergoing cardiac surgery: a meta-analysis. PLoS One. 2016; 11(4): e0152829. doi:

1371/journal.pone.0152829. PMID: 27049318, PMCID: PMC4822865.

Jaionen J, Hynynen M, Kuitunen A, Heikkila H, Perttila J, Salmenpera M, et al. Dexmedetomidine as an

anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997; 86(2): 331-45. doi:

1097/00000542-199702000-00009. PMID: 9054252.

Talke P, Li J, Jain U, Leung J, Drasner K, Hollenberg M, et al. Effects of perioperative dexmedetomidine

infusion in patients undergoing vascular surgery. The Study of Perioperative Ischemia Research Group.

Anesthesiology. 1995; 82(3): 620-33. doi: 10.1097/00000542-199503000-00003.

Shingu Y, Kubota S, Wakasa S, Ooka T, Tachibana T, Matsui Y. Postoperative atrial fibrillation:

mechanism, prevention, and future perspective. Surgery today. 2012; 42(9): 819-24. doi: 10.1007/s00595- 012-0199-4. PMID: 22619000.

Hayashi Y, Sumikawa K, Maze M, Yamatodani A, Kamibayashi T, Kuro M, et al. Dexmedetomidine

prevents epinephrine-induced arrhythmias through stimulation of central alpha 2 adrenoceptors in

halothane-anesthetized dogs. Anesthesiology. 1991; 75(1): 113-7. doi: 10.1097/00000542-199107000- 00018. PMID: 1676567.

Tobias JD, Chrysostomou C. Dexmedetomidine: antiarrhythmic effects in the pediatric cardiac patient.

Pediatric cardiology. 2013; 34(4): 779-85. doi: 10.1007/s00246-013-0659-7. PMID: 23435789.

Amar D, Burt ME, Bains MS, Leung DH. Symptomatic tachydysrhythmias after esophagectomy: incidence

and outcome measures. The Annals of thoracic surgery. 1996; 61(5): 1506-9. doi: 10.1016/0003- 4975(96)00111-7.

Polanczyk CA, Goldman L, Marcantonio ER, Orav EJ, Lee TH. Supraventricular arrhythmia in patients

having noncardiac surgery: clinical correlates and effect on length of stay. Annals of internal medicine.

; 129(4): 279-85. doi: 10.7326/0003-4819-129-4-199808150-00003. PMID: 9729180.

Mohammad AT, Asghar MA, Asadollah M, Jalal A, Javad S, Alireza SS, et al. The evaluation of right

atrial temporary pacing for preventing postoperative atrial fibrillation following coronary artery bypass

grafting surgery: prospective observational study. Life Science Journal. 2012; 9(3): 2233-7.

Zirak N, Soltani G, Abbasi M, Hamadanchi A, Moeinipour AA, Javan H, et al. Prophylactic Effect of a

Single Intravenous Dose of a Combination of Digoxin, Hydrocortisone, and Amiodarone on Atrial

Fibrillation after Off-Pump Coronary Artery Bypasses Graft Surgery. Iranian Heart Journal. 2012; 13(3):

-8.

Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the

management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical care

medicine. 2013; 41(1): 263-306. doi: 10.1097/CCM.0b013e3182783b72. PMID: 23269131.

Kamibayashi T, Maze M. Clinical uses of α2-adrenergic agonists. Anesthesiology. 2000; 93(5): 1345-9.

doi: 10.1097/00000542-200011000-00030. PMID: 11046225.

Maze M, Scarfini C, Cavaliere F. New agents for sedation in the intensive care unit. Crit Care Clin. 2001;

(4): 881-97. doi: 10.1016/S0749-0704(05)70185-8. PMID: 11762266.

Videira RL, Ferreira RM. Dexmedetomidine and asystole. Anesthesiology. 2004; 101(6): 1479-80. doi:

1097/00000542-200412000-00038. PMID: 15564965.

Ingersoll-Weng E, Manecke GR, Thistlethwaite PA. Dexmedetomidine and cardiac arrest. Anesthesiology.

; 100(3): 738-9. doi: 10.1097/00000542-200403000-00040. PMID: 15108994.

Imazio M, Brucato A, Ferrazzi P, Pullara A, Adler Y, Barosi A, et al. Colchicine for prevention of

postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial.

JAMA. 2014; 312(10): 1016-23. doi: 10.1001/jama.2014.11026. PMID: 25172965.

Halonen J, Halonen P, Järvinen O, Taskinen P, Auvinen T, Tarkka M, et al. Corticosteroids for the

prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA. 2007; 297(14):

-7. doi: 10.1001/jama.297.14.1562. PMID: 17426275.

Published

2022-02-12