Abstract and Introduction
Abstract
Background: Dexmedetomidine (DEX) has a pharmacological profile that should allow rapid recovery and prevent undesirable outcomes such as pulmonary complications.
Methods: This large retrospective study compared the beneficial effects of perioperative infusion of DEX with propofol on the postoperative outcome after coronary artery bypass graft surgery. We reviewed patients' medical notes at Luoyang Central Hospital from 1st January 2012 to 31st December 2019. All continuous variables, if normally distributed, were presented as mean ± SD; Otherwise, the non-normally distributed data and categorical data were presented as median (25–75 IQR) or number (percentage). The Mann-Whitney U test and Chi-square test were used to evaluate the difference of variables between the DEX and propofol groups. Multivariate logistic regression analysis was performed on the main related and differential factors in the perioperative period.
Results: A total of 1388 patients were included in the study; of those, 557 patients received propofol infusion, and 831 patients received dexmedetomidine. DEX significantly reduced postoperative pulmonary complications compared with propofol, 7.82% vs 13.29%; P < 0.01, respectively. When compared with propofol, DEX significantly shortened the duration of mechanical lung ventilation, 18 (13,25) hours vs 21 (16,37) hours; P < 0.001, the length of stay in the intensive care unit, 51 (42,90) vs 59 (46,94.5) hours; P = 0.001 and hospital stay, 20 (17,24) vs 22 (17,28) days; P < 0.001, respectively. The incidences of postoperative wound dehiscence and infection were significantly reduced with DEX compared with propofol groups, 2.53% vs 6.64%; P < 0.001, respectively. Interestingly, patients receiving DEX had significantly shorter surgical time compared to propofol; 275 (240,310) vs 280 (250,320) minutes respectively (P = 0.005) and less estimated blood loss (P = 0.001).
Conclusion: Perioperative infusion of dexmedetomidine improved the desirable outcomes in patients who had coronary artery bypass graft surgery compared with propofol.
Introduction
The optimum intraoperative anaesthetic agent for cardiac surgery should allow the patients to recover rapidly and prevent undesirable outcomes such as pulmonary complications, prolonged mechanical lung ventilation, and prolonged stay in the intensive care unit (ICU). Prolonged mechanical ventilation and ICU stay are associated with high morbidity and mortality rates following cardiac surgery.[1,2] Anaesthetic techniques and agents used during surgery to accelerate weaning from mechanical lung ventilation and patient's recovery are essential for fast-track cardiac anaesthesia and are increasingly being adopted.
Dexmedetomidine (DEX) is a highly selective short-acting α2-adrenoceptor agonist with properties including sedative, analgesic, anxiolytic, opioid and anaesthetic sparing effects.[3] DEX has minimal impact on respiratory depression, improves oxygenation and lung compliance, and reduces postoperative pulmonary complications.[4,5] DEX also alleviates perioperative stress, inflammatory and immune response leading to an excellent postoperative recovery.[6] Perioperative use of DEX as an anaesthetic adjunct and postoperative sedation was reported to reduce the time spent on mechanical ventilation, improve 30 days mortality, shorten ICU and hospital stay, and decrease postoperative complications, including the incidence of pulmonary complications and delirium and acute kidney injury.[7,8]
Several studies demonstrated the benefit of DEX infusion in providing haemodynamic stability during cardiac surgery.[9–11] Meta-analysis studies on the use of DEX during cardiac surgery also showed a reduction in the risk of atrial fibrillation, ventricular tachycardia and cardiac arrest.[7,12] The potential impact of the haemodynamic stability provided by DEX during cardiac surgery on intraoperative outcomes is still limited.
In this study, we analysed our patients' data retrospectively. We investigated the potential benefits of DEX compared to propofol during and after anesthesia and surgery on postoperative outcomes in patients undergoing coronary artery bypass graft surgery (CABG). We also explored the potential benefits of DEX infusion during surgery on intraoperative outcomes such as blood loss, blood transfusion, duration of anaesthetic and surgery, and opiates consumption in those patients.
BMC Anesthesiol. 2022;22(51) © 2022 BioMed Central, Ltd.
